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COUNTY OF SAN JOAQUIN <br /> °►�° " ° OFFICE OF EMERGENCY SERVICES <br /> a ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE <br /> • 4.., i'..:;� 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 /> kf../4SIP'!v� 571 <br /> Z d7,9—l,/G,l-- 5/J(-/ <br /> BUSINESS ADDRESS(Facility Being Inspected) ZIP CODE <br /> /TOZ Al (,/i(-so✓ t,Jy. S, e� roti/ 9Szo� <br /> FIRE DISTRICT INSPECTION DATE ARRIVAL TIME DEPARTURE TIME INSPECTOR NAME/AGENCY <br /> ZZ /—C�-0tf� I /SVf "A-�c� / ocr <br /> DOCUMENT REVIEW YES NO FACILITY 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 Employees �/ 9.Hazardous Materials/Waste Properly Labelled <br /> 10. Conditions noted that could increase risk of releas <br /> 5.Training/Exercise Records Available or hinder implementation of emergency lan <br /> EXPLANATION OF FINDINGS AND COMMENTS <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 OES for user name and password. <br /> INSPECTION FOLLOW-UP INFORMATION <br /> Corrective Actions Must Be Submitted By Follow-Up Inspection Date Referral Actions <br /> (if appropriate) ❑SJ Ag [:]SJ Env Hlth ❑OSHA [:]Fire ❑ Air Dist <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) I Business R entative(Signature) <br /> WHITE COPY: OES <br /> N <br /> !A nec PINK COPY: BUS. <br /> V07 <br />