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PgUrp COUNTY OF SAN JOAQUIN <br /> so. .co` OFFICE OF EMERGENCY SERVICES <br /> a2101 E. Earhart Avenue, Suite 300 <br /> Stockton,California 95206 <br /> ---i Telephone:(209)953-6200 <br /> Fax:(209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME ADDRESS(Facility Being Inspected) <br /> s 1 /00/--S- 4.✓ <br /> ACCO # START DATE(New Bus) INSP ION ATE ARRIVAL TIME IDEPARTURETIMIF INSPECT RNA E <br /> 2-cillo /foo �i/ zs �w z <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 n; <br /> 2.Business Identification Page Complete&Accurate 7. Presence of Non-Listed Regulated Chemicals <br /> 3.Business HMMP Complete and Accurate V 8. Employees Familiar with HMMP <br /> 4.Chemical Descriptiou Pages Complete and Accurate 9. Hazardous Materials/Waste Properly Labelled <br /> 5.Training Records Available10. Conditions that would hinder implementation of <br /> �e Emergency Plan or increase risk of release are absent <br /> EXPLANATION OF FINDINGS AND COMMENTS / /J <br /> hLK�/KL <br /> 4.7 L t A..C✓1/ i / /.1' Kd /0 2 - .S'/.1-e- <br /> 2- <br /> S'/ T 1'C. . <br /> Z ' A. Va,_.., 4 a ,� �d za. ✓c1�.E r../ 4ts J*, r 4'_-)e <br /> .� �:<. � -,r� �".'� 6-sf2e✓ e/mac /C®z1�� <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Additional <br /> To Be Submitted By: -5 /////0 Referrals/Notes: <br /> ACKNOWLEDGEMENT F REIVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print <br /> �,,Namle and Title) Business Rep sentative(Signature) WHITE COPY: DES <br /> t/Jno PINK COPY: BUSINESS <br /> REV 12/08 <br />