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1 <br /> oPgu, Ask <br /> N, c COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES <br /> 4 a 2101 E. Earhart Avenue, Suite 300 <br /> " ` ` Stockton,California 95206 <br /> Telephone: (209)953-6200 <br /> cq i o;a a�P Fax: (209)953-6268 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS N ME ADDRESS(Facilit Being Inspected <br /> ' r <br /> ACCOUNT# START ATE( Bus) I),PE7 I Nf`DATE AR`RICVAL TIME DEPARTUR TIME I SPECT R N E <br /> Cl f J <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 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 /> [A' .-71 -0 <br /> INSPECTION FOLLOW UP INFORMATION <br /> orrective Actions FR <br /> dditional <br /> o Be Submitted By: eferralslNotes: <br /> 'ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Re i ature) WHITE COPY: OES <br /> PINK COPY: BUSINESS <br /> REV 12108 <br />