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Ank <br /> Pquip COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> Q' a 2101 E. Earhart Avenue, Suite 300 <br /> " ` ` Stockton,California 95206 <br /> Telephone: (209)953-6200 <br /> Fax: (209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME ADDRESS(Facility Being Inspected) <br /> oL C L r''ekA&L -�2- Lego c lY <br /> ACCOUNT# START DAff E(New us) INSPECTION DATE ARRIVAL TIME DEPARTURE TIME 1NSPE OR NAME <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.HMMP/Map On Hand and Easily Accessible 5. Facility Map Complete and Accurate <br /> 2.Business Identification Page Complete&Accurate 6. Employees Familiar with HMMP <br /> 3.Business HMMP Complete and Accurate o, 7. Training Records Available <br /> 4.Chemical Description Pages Complete and Accurate 8. Unsafe Conditions Observed(see details below) <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> o-. <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective ActionsAdditional <br /> To Be Submitted By: Referrals/Notes:/ <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Busines5�-Representative(Pr t Name and Title) Busine 5�Representative(Signature) <br /> "'1 5 WHITE COPY: <br /> OES <br /> 00� PINK COPY: BUSINESS <br /> REV 4110 <br />