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PQUIp COUNTY OF SAN JOAQUIN <br /> so. .caG OFFICE OF EMERGENCY SERVICES <br /> a 2101 E. Earhart Avenue,Suite 300 <br /> y' ` Stockton,California 95206 <br /> Telephone:(209)953-6200 <br /> iF �P Fax:(209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME ADDRESS(Facility Being Inspected) <br /> 4 t�' is Is /-4-P_7-A /0 /P E. W 0'0 A6 FszQr- <br /> ACCOUNT# START DATE(New Bus)JINSPECTION DATE ARRIVAL TIME DEPARTURE TIME INSPECTOR NAME <br /> Zo a 7 2 - 2- 0 9 /s-oo �,r/ <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 <br /> 2.Business Identification Page Co &Accurate 7. Presence of Non-Listed Regulat lcals <br /> 3.Business HMMP C etc and Accurate 8. Employees F ' 1az with HMMP <br /> 4.Chemi escription Pages Complete and Accurate 9 azardous 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 /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Additional <br /> ro Be Submitted By: Referrals/Notes: <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> usiness Representative(Print Nam and Tit e) Business Re resentative(Si nature) <br /> WHrrE COPY: OES <br /> PINK COPY: BUSINESS <br /> J vL. REV 17108 <br />