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COUNTY OF SAN JOAQUI <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> STOCKTON, CA 95202-2709 <br /> BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUS NAME I ELEP ONE NUMBER <br /> Sy� 6 (P-SZ99 <br /> BUSINESS ADDRESS( acility 5 Inspected ZIP CODE <br /> 775 3e C-0 SS c - , C/Zo <br /> FIRES DISTRICT (NSP ON ATE ALTIME IDEPASTURET11,4E INSPECTOR NA A CY <br /> Ie <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.Business HMMP Complete and Accurate 6.Facility Map Complete and Accurate <br /> 2.Chemical Description Pages ete and Accurate 7.Chemical Inventory Complete and Accur <br /> 3.Business Identifi n Page Complete and Accurate 8. Employees Familiar w' P <br /> 4.HMMP ap Easily Accessible to Employees 9.Hazazdou erials/V✓aste Properly Labelled <br /> 5. raining/Exercise Records Available 10.C (tions noted that could increase risk of releas <br /> or hinder implementation of emer enc Ian <br /> EXPL_1NATION OF FINDINGS AND COMMENTS <br /> eJ- <br /> NOTE: All HMMP documents except for the Facility Map can be created and updated on the San Joaquin County <br /> HMMP Compliance Website at www.sjoesdata.org. Contact OES for user name and password. <br /> INSPECTION FOLLOW-UP INFORMATION <br /> Corrective Actions Must Be Submitted By Follow-Up Inspection Date Referral Actions <br /> (if appropriate) ❑SJ Ag ❑SJ Env Hlth OSHA []Fire ❑ Air Dist <br /> �Nl 23 2-00 -7 p <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Representative(Signature) <br /> uDq WHITE COPY: OBS <br /> 1L7� �/ � IY�� PINK COPY: BUS. <br /> 4107 <br />