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a Ah <br /> COUNTY OF SAN JOAQUIIT <br /> �aF cpc OFFICE OF EMERGENCY SERVICES <br /> a ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> .., STOCKTON, CA 95202-2709 <br /> BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> BUSINESS ADDRESS facility Being I spected) ZIP CODE <br /> 't6 6, O <br /> FIRE DISTRICT INSPECTION DATE ARRIVAL T DEPARTURE TIME INSPECTOR NAMEIAGENCY <br /> DOCUMENT REVIEW YES NO FACILr WALK THROUGH YES NO <br /> 1.Business HMMP Complete and Accurate ?5 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 /> D or hinder implementation of emergency lan <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> 5� ryl L J lr02J -d' -- <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 /> i (if appropriate) SJ Ag [—]SJ Env Filth OSHA Fire Air Dist <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Repres tive re) <br /> � WHITE COPY: OPS <br /> u�k le_& r _ PINK COPY: BUS. <br /> l M07 <br />