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OPAUIN COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> 2101 E. Earhart Avenue,Suite 300 <br /> Stockton,California 95206 <br /> Telephone:(209)953-6200 <br /> cacicbii�'' Fax: (209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME V, ADDRESSS(Facility Being Inspecteedd)) <br /> CCOUNT# START DATE(New Bus) INSPECTION D TE ARRIVAL TIME DEPART TIME INSPECTOR SAME <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES 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 <� j,_ •� <br /> 3.Business HMMP Complete and Accurate 8. Employees Familiar with HMMP tj <br /> d.Chemical Description Pages Complete and Accurate S'CE led 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 /> EXPLANATION OF FINDINGS AND COMMENTS <br /> h���/� �o•..,ec:1 G�it/f/6/✓�O <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions p Additional <br /> To Be Submitted By: /L /��j Referrals/Notes: x'118 <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> usiness Representative(Print Name and Title) Business presents 've(Signature) <br /> WHITE COPY: OES <br /> �. �---- PINK COPY: BUSINESS <br /> aev twos <br />