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oPytul}y COUNTY OF SAN JOAQUIN `*AO <br /> o� OFFICE OF EMERGENCY SERVICES <br /> a2101 E. Earhart Avenue,Suite 300 <br /> Stockton,California 95206 <br /> Telephone:(209)953-6200 <br /> ea<ikoaNs� Fax:(209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME C-1w_*&e— 'b�CR SYSr-E.`t.S ADDRESS(Facility Being Inspected) <br /> .Ty, '2E se-_s 1 (0905' 5re A fz/o <br /> ACCOUNT# START DATE(New Bus) INSPECTION DATE ARRIVAL TIME DEPARTURE TIME INSPECTOR NAME <br /> l' <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 Co e&Accurate 7. Presence of Non-Listed Regulated Icals <br /> 3.Business HMMP Co to and Accurate 8. Employees Famil' tth HMMP <br /> 4.Chemic scription Pages Complete and Accurate 9. Haz us Materials/Waste Properly Labelled <br /> 5.<ining Records Available tT Conditions that would hinder implementation of <br /> Emergency Plan or increase risk of release are absent <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> /Vb C-NF'/'a S m n/ SijG <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Additional <br /> To Be Submitted By: Referrals/Notes: <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT O INSPECTION RESULTS <br /> usmess esentative rint Nam and I t]"66 Business Re resentative( Ignature) <br /> • .�G I WHITE COPY: US <br /> r'(�' PINK COPY: BUSINESS <br /> REV IV <br />