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oq��lN COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> a = 2101 E. Earhart Avenue,Suite 300 <br /> Stockton,California 95206 <br /> ^_ Telephone:(209)953-6200 <br /> Fax:(209)953-6268 <br /> 6"i <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUS NESS NAME ADDRESS(Facility Being Inspected) <br /> a> ✓� IW6 -L -2,5- 5- Ud/ 1--e <br /> AC OUNT# START DATE(New Bus) INSPECHON DATE ARRIVAL TIME DEPARTU TIME INSP CIOR NAME <br /> U LI <br /> a �r <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> I.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 /> EXPLANATION OF FINDINGS AND COMMENTS <br /> fVMa n Corn c�" <br /> 4�7+ ' <br /> ro vac U6 n <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions /I <br /> o Be Submitted By: — ( 1— to Additional Referrals/Notes: <br /> CKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> ess Representahv (Print Name and Title) Busn Representative(Sig a e) <br /> � <br /> /� WHITE COPY: OES <br /> 1 brie j PINK COPY: BUSINESS <br /> REV 17106 <br />