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Q, N COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> ROOM 610, COURTHOUSE <br /> a` 222 EAST WEBER AVENUE <br /> �q�iFc"aN`T• STOCKTON, CA 95202-2709 <br /> BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> wc ✓ - <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIP CODE <br /> 2D 2 Cl tl <br /> FIRE DISTRICT INSPECTION DATE ARRIVAL TIME DEPARTURE TIME INSPECTOR NAMEJAGENCY <br /> Z LI 1& f 3C Farr I <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.Business HMMP Complete and Accurate 6.Facility Map Complete and Accurate Zr <br /> 2.Chemical Description Pages Complete and Accurate 7.Chemical Inventory Complete and Accurate <br /> 3.Business Identification Page Complete and Accurate a" 8. Employees Familiar with HMMP <br /> 4. HMMP/Map Easily Accessible to Employees (f 9.Hazardous Materials/Waste Properly Labelled } <br /> 5.Training/Exercise Records Available 10.Conditions noted that could increase risk of release1 / <br /> or hinder implementation of emergency Ian d <br /> EXPLANATION OFYINDINGS AND COMMENTS <br /> NOTE: All HMMP documents except for the Facility Map can be created and updated on the San Joaquin County <br /> IIMMP Compliance Website at www.sjoesdata.org. Contact OES for user name and password. <br /> INCKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTSSPECTION 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 /> Business Representative(Print Name and Title) Business Re sen Signature) <br /> `/ WHITE COPY: OBS <br /> I N C)T7 g S C o� �� PINK COPY: BUS. <br /> M07 <br />