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COUNTY OF SAN JOAQUIN <br /> Pp U f fy OFFICE OF EMERGENCY SERVICES <br /> ROOM 610, COURTHOUSE <br /> 222 EAST WEBER AVENUE -I- <br /> 12 Y O O <br /> STOCKTON, CA 95202-2709 <br /> C9��ROFta`P BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAW / TELEPHONE NUMBER <br /> SI 190 � �' l / �r s Fo _)�Po <br /> BUSINESS ADDRESS(Facility Being inspected) ZIP CODE <br /> FIRE DISTRICT INSPECTION .ATE ARRIVALTD41f. DEP RTURE TE INSPECTOR NA A ENCY <br /> 2,1 <br /> DOCUMENT REVIE 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 L�_f 7.Chemical Inventory Complete and Accurate <br /> 3.Business Identification Page Complete and Accurate I 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 /V �t or hinder implementation of emergency lan <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> Ate P. <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 /> 4-e- L �� Zo ❑ <br /> CKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Representative(Signature) <br /> WHITE COPY: Ol?S <br /> PINK COPY: �� <br />