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Nov 08 07 08: 29a San Joaquin OES 209-468 0273 p. 2 <br /> COUNrr Y OF SAN JOA,QUINutt - <br /> �o OFFICE OF EMERGENCY SERVICES <br /> y 'z4 ROOM 610, COURT HOtJSE <br /> 222 EAST WEBER AVENIJE d" <br /> STOCKTON, CA 95202-2709 <br /> `,FopN BUS. (209) 468-3969 FAX (209) 468-0273 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION ]FORM <br /> WISINESS NAME TFI.F.P110NE NUMN".11 <br /> Go Q Y o /�•`�2r 1' fir- S3©9 <br /> BUSINE.;S ADDRESS(Fucility Being In>:pcewdl ' ZIP CODE <br /> Q _ /Q--�) -Y-2 C7 S <br /> FIRE DISTRICT INSPECTION DATH I ARRIVALTIMI�. DEPARTURE TINil; WPECTORNAMEIM(it:NCY <br /> Z Z <br /> ///7�0 7 /S o o �rwcz` ��� <br /> DOCUMENT REVIEW YES NO i :,wil.1TY WALKTIIROUGH YES NO <br /> 1.Business HMMP Complete alld Accurate Cr. facility Map Complete.and Accumte -� <br /> 2.Chemical Description Pages(."Oni)l• i Accut'ate 7.Chemical Inventory Collurate <br /> 3. Business Identification ' ,e Comp ete and Accurate — - — S 1:mpli�yces F Iar with HMMP <br /> 4. HMMP/M asily Accessible to Employees 9.1I ous Materials/Waste Properly Labelled <br /> i 10.Conditions rioted that COuld increase risk of releas <br /> 5.Tr ' ing/irxercise Records nvailahlc <br /> or hinder int Ict11ei1tatlOtl Of emergency Ian <br /> KXPLANATION 01; V INIHNGS ANIS COMMENTS <br /> NOTE: All IIMMP documents except for the Facility Map can be created and updated on the Sari .Joaquin County <br /> JIMMP Compliance Website at www-Sjo0da1a.org. Contact 011'.S for user name and password. <br /> INSPECTION FOLLOW-UP INFORMATION <br /> COrTcctive Actions Must Be Submitted By Follow-Up Inspection Date Referral Actions <br /> (if appropriate) ❑S.i Ag ❑SJ Env Hith ❑OSI•JA ❑Fire ❑ Air Dist <br /> ACKNOWLEDGEMENT OF RFVIEW AND RECEIPT OF INSPF,CTION I 1?SULTS <br /> Business Representative(Print Narne and Title) Busi 'sl preset tv (Signature) - <br /> J — W Hl'1'E COPY: OES <br /> PIN <br /> ( I� ��✓ I (. �"�I 1� �T-J 11 �,��1 t✓.✓L �i - ICCOPY: 13107. <br /> 4/(17 <br />