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o Pqu!N COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> ? 2101 E. Earhan Avenue, Suite 300 <br /> Stockton,California 95206 <br /> ` Telephone:(209)953-6200 <br /> o{CiPGRN`P Fax:(209)953-6268 /^ <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM GISz�J <br /> B NESS NAME // // ADDRESS(Facility Be'ng Inspected) <br /> S �( estou r� 7 - 343.3 S. !/7/ 9 oCAO 14 <br /> ACCOUNT# TART DATE(New Bus) INSP ION ATE ARRIVAL TIME DEPARTCRE TINZ JINSP�r RNA <br /> /0Vcr6 7 /7 /o /SOv /S2O ��- � ez <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.HMMP/Map On Hand and Easily Accessible Facility Map Complete and Accurate <br /> 2.Business Identification Page Complete&Accurate 6. Employees Familiar with HMMP ' <br /> 3.Business HMMP Complete and Accurate 7. Training Records Available <br /> 4.Chemical Description Pages Complete and Accurate 8. Unsafe Conditions Observed(see details below) <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> # I ;x _s. <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Additional y� <br /> To Be Submitted By: Refe o[es: K�—//7l .1614 0t4 /-7 /d <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF I ON RESULTS PLO <br /> Business Resentative(Print Name and Title) B 'ness Representative Signature) <br /> WHITE COPY: OES <br /> PINK COPY: BUSINESS <br /> U , coREV 4110 <br />