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1b a <br /> COUNTY OF SAN JOAQUIN <br /> Iap4coc FFICE OF EMERGENCY SERVICES <br /> a ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> • `'�tFoda �.. 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 /> 937- 8zs�� <br /> BUSINESS ADDRESS(Facility Beim Inspecte ) ZIP CODE <br /> zo D' SrAy✓71-� 9-<- o <br /> FIRE DISTRICT INSPECTION D TE ARRIVAL TIME IDEPARTURETRAE I INSPECTOR NAMEIAGENCY <br /> 2Z �-�-.t /oe--T <br /> DOCUMENT REVIEW YES NO FACII ITY WALK THROUGH YES NO <br /> 1.Business HMMP Complete and Accurate ,-- 6.Facility Map Complete and Accurate ✓ <br /> 2.Chemical Description Pages Complete and Accurate 7.Chemical Inventory Complete and Accurate <br /> 3.Business Identification Page Complete and Accurate 8. Employees Familiar with HMMP <br /> 4.HMMP/Map Easily Accessible to Emplc yees 9.Hazardous Materials/Waste Properly Labelled <br /> 5.Training/Exercise Records Available /10.Conditions noted that could increase risk of releas <br /> or hinder implementation of emei enc lan <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> ` _ I <br /> 7a 41f40 Crc�+rcyc.c �rr_cz <br /> - 00'�-A-.tel oVo .4�4cr cow ia oo0c-A- f <br /> a <br /> ArJ e-Asrc.Y Pc-F-e—c. <br /> co P Y o f0IAC- Win[/'C-0 � <br /> Isc E 3 Tient wl O n[ _ OeLft-Af_ - <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 DES for user name and password. <br /> INSPECTION FOLLOW-UP INFORMAI ION <br /> Corrective Actions Must Be Submitted By ollow-Up Inspection Date Referral Actions <br /> if appropriate) ❑SJ Ag E]SJ Env Hlth OSHA Fire ❑ Air Dist <br /> ❑ <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Til le) Business Representab (Signature) <br /> I �Lf�i _ WHITE COPY: OES <br /> 61anza11Z_ �S /�-f(' oe PINK COPY: 4ro7 <br />