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COUNTY OF SAN JOAQUIN <br /> OFFICE OF EMERGENCY SERVICES ::�ECEIVEFL <br /> ROOM 610,COURTHOUSE <br /> 222 EAST WEBER AVENUE DEC 14 2005 <br /> STOCKTON, CALIFORNIA 95202 �)wv YuHUUiN UUUNrY <br /> F HAZARDOUS MATERIALS DIVISION(209)468-3969 '7FFICE Ur EMERGENCY SERVICES <br /> FAX(209)944-9015 <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION FORM <br /> BUSINESS NAME TELEPHONE NUMBER <br /> Auto — Chlor System 523-5334 <br /> BUSINESS ADDRESS(Facility Being Inspected) <br /> 1122 Bessemer Avenue, Manteca, CA 95337 <br /> FIRE DISTRICT INSPE TION DATE ARRIVAL TIME DEPARTURE TIME INSPECTION TYPE <br /> 24 g d I I - lS �-, I 1�! 0 0 , BMMP <br /> INSPECTION RESULTS <br /> DOCUMENT REVIEW YES NO FACILITY INSPECTION YES NO <br /> 1. Business HMMP/Inventory On Site 2.Facility Map Complete and Accurate <br /> 2. HMMP/Map Easily Accessible to Employees 8. Chemical Inventory Complete and Accurate <br /> 3.Bus ID Page/HMMP Complete and Accurate V 9. Employees Familiar with HMMP <br /> 4. If Business is a Hazardous Waste Generator, 10.Plant Operations Appear Safe <br /> are Hazardous Waste Manifests On Site? 11.Hazardous Materials Being Properly Handled by Employees <br /> 5. Material Safety Data Sheets (MSDS) On Site 12.Hazardous Materials Properly Stored and Labeled <br />-`` 6.Current Training Records On Hand 13.Soil and Facility Appear Non-Contaminated <br /> COMMENTS (Items marked"NO"above must be explained in this section) <br /> tiQL,� , . <br /> �y / w/ <br /> lS /'P 0,-0 <br /> q. a5ij <br /> 44 <br /> REFERRALS ❑SJ Ag ❑SJ En% lilth ❑ OSHA ❑Fire ❑DA ❑ <br /> INSPECTION FOLLOW UP INFORMATION <br /> Corrective Actions Must be Delivered to OES By Follow Up Inspection Date OES Inspector Name Performing Follow Up <br /> l.z 8- o — m,` . s ' <br /> ACKNOWLEDGEMENT OF REVIEW AND RECEIPT OF INSPECTION RESULTS <br /> Business Representative(Print Name and Title) Business Representative(Signature) <br /> -T;el\ k;>, Q-Z- , (8z,r <br /> Name of Inspector Agency --// Fire Co. (If Appropriate) WHITE COPY: OEs REV 9/02 <br /> J'Y�F .` PINK COPY: BUSINESS <br />