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Ifto <br /> COUNTY OF SAN-JO-AQUI <br /> ?°PRS£oma OFFICE OF EMERGENCY SERVICES <br /> r` ROOM 610, COURTHOUSE <br /> b' <br /> 222 EAST WEBER AVENUE <br /> ;...... .. .;� STOCKTON, CA 95202-2709 <br /> BUS. (209) 468-3969 FAX (209) 468-0273 <br /> BUSINESS NAME HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> r/ TELEPHONENUMBER <br /> � � 11 Y -6160 <br /> BUSINESS ADDRESS(Facility Bein Inspec� 'A/ted) ZIP CODE <br /> q� <br /> FIRE <br /> DISTRICT INSPECTIO DATE A NAL TMIE DEPARTURE TM INSPECT15—Rin AMF/AGENCY <br /> - <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.Business HMMP Complete and Accurate ?S 6.Facility Map Complete and Accurate !P <br /> 2.Chemical Description Pages Complete and Accurate 7.Chemical Inventory Complete and Accurate 7 <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 IX <br /> EXPLANATION OF FINDINGS AND COMMENTS <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 DES for user name and password. <br /> INSPECTION FOLLOW-UP INFORMATION <br /> Corrective Actions Must Be Submitted By Follow-Up Inspection Date Referral Actions <br /> (if appropriate) ❑SJ Ag 0 S Env Hlth ❑OSHA ❑Fire ❑ Air Dist <br /> El <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Representative(Signature) <br /> / WHITE COPY: OES <br /> t <br /> Q/ PINK COPY: BUS. <br /> am <br />