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>_ <br />"I <br />COUNTY OF SAN JOAQUIN <br />a"f" OFFICE OF EMERGENCY SERVICES <br />ROOM 610, COURTHOUSE <br />222 EAST WEBER AVENUE <br />STOCKTON, CA 95202-2709 <br />9�rFOP? BUS. (209) 468-3969 FAX (209) 468-0273 <br />HAZARDOUS MATERIALS PROGRAM INSPECTION FORMILLtFj4uNE NUMBER <br />BUSINESS NAME <br />(!?Lt al L L,a K, je sC,a� l../r�s H Zo9- 9s -to- yoga <br />BUSINESS ADDRESS (Facility Being Inspected) ZIP CODE <br />e/(oco/ uAI� Ls}Kr s' cicr+o� 1�Zo7 <br />FIRE DISTRICT INSPECCIONDATE ARRIVAL TIME DEPAR'I'URETF4 INSPECPORNAMFIAGENCY <br />2 Z_ - /`i- 07 /O: 2 f L�✓ri L Atte r+%/ <br />DOCUMENT REVIEW YES NO FACILITY WALK THROUGH YES NO <br />1. Business HMMP Complete and Accurate <br />✓ <br />6. Facility Map Complete and Accurate <br />2. Chemical Description Pages Complete and Accurate <br />7. Chemical Inventory Complete and Accurate <br />3. Business Identification Page Complete and Accurate <br />8. Employees Familiar with HMMP <br />4. HMMP/Map Easily Accessible to Employees 9. Hazardous Materials/Waste Properly Labelled <br />10. Conditions noted that could increase risk of releas <br />5. Training/Exercise Records Available or hinder implementation of emergency lan <br />EXPLANATION OF FINDINGS AND COMMENTS <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 Referral Actions <br />Corrective Actions Must Be Submitted By Follow -Up Inspection Date <br />(if appropriate) ❑ SJ Ag ❑ SJ Env Hlth []OSHA ❑ Fire ❑ Air Dist <br />ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br />Business Representative (Print Name and Title) Bess Representative (Signature) <br />\ WHITE COPY: OFS <br />n' PINK COPY: BUS. <br />1 h'CI�t�K '✓ MF Akef_ 4107 <br />V" <br />