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Pquty COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> a 2101 E. Earhart Avenue,Suite 300 <br /> Stockton,California 95206 <br /> ' Telephone:(209)953-6200 <br /> c'fi:icoa"sY' Fax: (209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM 95 Z D S< <br /> BUSINESS NAME ADDRESS(Facility Being Inspected <br /> r `I.-ae 38OS <br /> A/3 UNT#09! SART DATE(New Bus) INSPECTION BATE ARRIVAL TIME DEQ RJ'UR F,'FIME INSPE �OR�NQ <br /> U U b INSPPECTIONN RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.HMMP/Map On Hand and Easily Accessible L116. Facility Map Complete and Accurate �- <br /> 2.Business Identification Page Complete&Accurate 647. Presence of Non-Listed Regulated Chemicals <br /> 3.Business HMMP Complete and Accurate 8. Employees Familiar with HMMP <br /> 4.Chemical Description Pages Complete and Accurate 9. Hazardous Materials/Waste Properly Labelled <br /> 5.Training Records Available 0. Conditions that would hinder implementation of <br /> Emergency Plan or increase risk of release are absent v <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> IIOO <br /> rCKNOWLEDGEMENT <br /> LLOW UP INFORMATION <br /> ns �� �0 1 Additional <br /> By: 4. / Referrals/Notes: <br /> EMENT OFR IEW ND RECEIPT OF INSPECTION RESULTS <br /> ntative(Print Name and Title) Bustes p ntah ( tgnature) <br /> WHITE COPY: OES <br /> PINK COPY: BUSINESS <br /> REV 121081 <br />