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o�Auly COUNTY OF SAN JOAQUIN <br /> ' '•oc OFFICE OF EMERGENCY SERVICES <br /> a• ? 2101 E. Earhart Avenue, Suite 300 <br /> Stockton,California 95206 <br /> Telephone:(209)953-6200 <br /> Fax: (209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSIN,E/�S NAME ADDRESS(Facility Being Inspected) <br /> fi ' o 2--z9 C:� 9szas- <br /> ACCOUNT# START DATE(New Bus) INSPECTION DATE JARRIVALTIME DEPARTURETIME INSPECTOR NAME <br /> 1 ©1 <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1. HMMP/Map On Hand and Easily Accessible ✓ 6. Facility Map Complete and Accurate 1/ <br /> 2.Business Identification Page Complete&Accurate ✓ 7. 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 ✓ 10. Conditions that would hinder implementation of <br /> Emergency Plan or increase risk of release are absent <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> S- Hsr,✓E s AI c©Os' oG r7yPcvy�� 4r�Ji,I/G <br /> Gree,e 7v ccs. o Q rl p c n s� oG T49i.✓i 'u�, �re>✓rs <br /> INSPECTION FOLLOW UP INFORMATION <br /> orrective Actions q Additional <br /> To Be Submitted By: ,f' 7-CrJ/ Referrals/Notes: <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) <br /> /J(' Business resentativ $ nature) <br /> WHITECOPY: OESN15/tritE �Ci ✓� PINK COPY: BUSINESS <br /> REV 12/08 <br />