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Pau„� COUNTY OF SAN JOAQUIN. <br /> OFFICE OF EMERGENCY SERVICES <br /> 2101 E. Earhart Avenue, Suite 300 <br /> Stockton,California 95206 <br /> Telephone: (209)953-6200 <br /> CQLlFOR�,P Fax: (209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> USINESS NAME 1 o r _ AI J)rS4(Facility Being Inspected) ` <br /> CM — I i/ ck Pc.A 9- 2 / ' Le- GGJJ [(gS ,�fz ,k�e�e c1. rE(ZORr' �� L <br /> ACCOUNT# START DATE(New Bus) INSPE I DATE ARRIVAL TIME DEPARTURE TIME JIN NAME/ <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.HMMP/Map On Hand and Easily Accessible S. Facility Map Complete and Accurate <br /> 2.Business Identification Page Complete&Accurate 6. Employees Familiar with HMMP <br /> 3.Business HMMP Complete and Accurate 7. Training Records Available <br /> 4.Chemical Description Pages Complete and Accuratel I <br /> Unsafe Conditions Observed(see details below) <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> q-- a.W�a LA4-1_ O 4. �� <br /> lop f <br /> dt C1 S Q [ d dl O CJ.(/L B ✓ v1 tv�-S(A I/ �6� ��-. <br /> INSPECTION FOLLOW UP NFORMATION <br /> Corrective Actions Additional <br /> To Be Submitted By: 2 �d Referrals/Notes: <br /> CKN WL GEMENT OF REV AND RECEIPT OF INSPECTI SULTS <br /> B usi nedd Re resen a(Print Na e nd Title7 Busi ss prese five a ure) <br /> � <br /> tP <br /> TE COPY: OE5 <br /> /f K COPY: BUSINESS <br /> REV 4110 <br /> 1 <br />