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PQ�,N COUNTY OF SAN JOAQUIN <br /> �o. .coG OFFICE OF EMERGENCY SERVICES <br /> ` ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE 27 g3 <br /> STOCKTON, CA 95202-2709 <br /> BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUq2--2—)- <br /> T 9T I �- 600-X03 <br /> BUSINESS ADDRESS(Facility Being Ins cted) ZIPCODE <br /> ?I 7 ` -e-4 A el. `�S <br /> FIRE DISTRICT JINSPECTIODATE ARRIVAL TIME DEPAR TIME INSPECTOR NAME/AGENCY <br /> rfv,tiC_�. C.�,M, �'�g o 8' 0 9'o5- '.��i 70 d z/C e_'r <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 release <br /> 5.Training/Exercise Records Available �✓ or hinder implementation of emergency lan <br /> EXPLANATION OF FINDINGS AND COMMENTS 1 <br /> T pl 7 G�t ✓!4 A"_r_ 000- o S i'�i'o 0 7" f'1 Ae.✓.rc v1 <br /> S` GL S T'o 6.G_ i�� L��+ 7/i� mei�t�• -- <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 /> 4W zoor ❑ <br /> _ZK LEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Representative(Signature) <br /> WHITE COPY: OES <br /> PINK COPY: BUS. <br /> V 1 (�<1 T 4/07 <br />