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AIL a <br /> COUNTY OF SAN JOAQUI <br /> OFFICE OF EMERGENCY SERVICES <br /> 2` ? ROOM 610, COURTHOUSE <br /> ` 222 EAST WEBER AVENUE <br /> a,.. STOCKTON, CA 95202-2709 <br /> BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONENUMBER <br /> w adv IrQ, e� <br /> BUSINESS ADDR S(Facility Being Inspected) ZIP CODE <br /> 1 � P L (Gcn <br /> FIRE DISTRICT INSPECTIONDATE JARRIVALTIME T5UFARTURETIME JINIPECTORNAME/AGENCY <br /> CUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br /> 1.Business HMMP Complete and Accurate X 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 /> 5.Training/Exercise Records Available 10.Conditions noted that could increase risk of releas <br /> or hinder implementation of emer enc lan <br /> EXPLANATION OF FINDINGS AND COMMENTS <br /> c des <br /> h <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 /> ❑ <br /> ACKNOWLEDGE NT OF REVIEW A F INSPECTION RESULTS <br /> Business Repres le) Business Representative(Signature) <br /> WHITE COPY: OES <br /> ^ r f PINK COPY: BUS. <br /> /! G 4/07 <br />