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aPQu IN COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> Z 2101 E. Earhart Avenue, Suite 300 <br /> Stockton,California 95206 <br /> Telephone: (209)953-6200 <br /> Fax:(209)953-6268 <br /> FOP .;P <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME �2 ADDRESS(Facility Being Inspected) <br /> � aZ ►ti �,� 13 <br /> c,LTox # �Foa, q$ gtS cv 9 cJL� <br /> ACCOUNT# START DATE(New Bus) INSPECTION DATE ARRIVAL TIME DEPART E TIME SPECTOR NAM <br /> 9361 5� i / 40 <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.HMMP/Map On Hand and Easily Accessible 6. Facility Map Complete and Accurate <br /> 2.Business Identification Page Complete&Accurate 7. Presence of Non-Listed Regulated Chemicals <br /> 3.Business HMMP Complete and Accurate 8. Employees Familiar with HMMP <br /> 4.Chemical Description Pages Complete and Accurate 9. Hazardous Materials/Waste Properly Labelled <br /> 5.Training Records Available 10. Conditions that would hinder implementation of <br /> Emergency Plan or increase risk of release are absent <br /> EXPLANATII N OF FINDING <br /> (/Lg/ AND COMMENTS f <br /> /4,07 )r&( CO <br /> 1. Imo, os - �s� 1 LI) <br /> d':j 3 0 ata c� <br /> 00 0.0 e w C ' J_O_v" <br /> INSPECTION FOLLOW UPI FORMATION <br /> Corrective Actions Additional <br /> To Be Submitted By: Z� L0 Referrals/Notes: <br /> ACKNOWLEDGEMENT OrFaEVIEW AND RECEIPT OF INSPECTION RESUL <br /> usl f�p✓resentative(P ' t N me and tle) / Busines f e(Signature) <br /> Q � /�; WHITE COPY: US <br /> J C � (. GC PINK COPY: BUSINESS <br /> REV 12/08 <br />