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COUNTY OF SAN JOAQUI <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> �` ... STOCKTON, CA 95202-2709 <br /> gC�FOR? BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUS SNAME1 TELEPHONE NUMBER <br /> )a4 il./ <br /> BUSINESS ADDRESS(FacilifyiBeing Inspected) ZIP CODE <br /> 1 <br /> FIRE DISTRi T INS ECCION ATE JARRIVALTIME DEPARTURE TIME PECTORNAMF{AGENCY <br /> al kq" <br /> DOC NT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.Business HMMP Complete and Accurate 6.Facility Map Complete and Accurate <br /> 2.Chemical Description Pages Complete and Accurate 7.Chemical Inventory Complete and Accurate <br /> 3.Business Identification Page Complete and Accurate 8. Employees Familiar with HMMP <br /> 4. HMMP/Map Easily Accessible to Employees 9.Hazardous Materials/Waste Properly Labelled <br /> 5.Training/Exercise Records Available 10.Conditions noted that could increase risk of releas <br /> or hinder implementation of emergency lan <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> �O <br /> NOTE: All HMMP documents except for the Facility Map can be created and updated on the San Joaquin County <br /> HMMP Compliance Website at www.sjoesdata.org. Contact OES for user name and password. <br /> INSPECTION FOLLOW-UP INFORMATION <br /> Corrective Actions Must Be Submitted By Follow-Up Inspection Date Referral Actions <br /> (f appropriate) 1:1 SJ Ag Ej SJ Env Hlth OSHA Fire Air Dist <br /> ACKNOWLEDGEMENT OF/REREVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Bus' ss Representative(Signature) <br /> WHITE COPY: OES <br /> PINK COPY: BUS. <br /> (e N .LD ,E Q tuV a07 <br />