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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Telephone: (209)468-3420 Fax:(209)468-3433 Web:www.sicehd.com <br /> HAZARDOUS MATERIALS PROGRAM INSPECTION_REPORT <br /> Facility Facility Inspection <br /> Name. fl C(i \ `Z\._ <\`.,,.., ... .f- Phone. i�c:' 5-`�cV Date. nin2 <br /> Facility CERS <br /> Address: <Z�h a to <br /> Inspection ` Title: Phone: <br /> Contact: Yl'� 't .`(� e.�o .\ 6 Lo�a� �ut�-gOG <br /> Inspection Program: <br /> Type <br /> Consent Given For: Consent <br /> Inspection VrPhotos ❑ Sampling Given By: Ce\'y"<� <br /> CCR=California Code of Regulations HSC=Health and Safety Code CFR=Code of Federal Regulations <br /> V=Violation R=Repeat COS=Corrected on site during inspection <br /> Violations V R:..i COi <br /> 1 HSC 25507 Failed to establish and implement a hazardous materials business plan(V334) 0 0 <br /> 2 HSC 25508(a)(1) Failed to electronically submit a business plan(V335) ❑ ❑ <br /> 3 HSC 25508(c) Failed to annually review and certify that the business plan is complete,accurate,and up to date(V342) o ❑ <br /> 4 HSC 25505.1 Failed to notify property owner that facility is subject to and in compliance with the HMBP program(V341) o ❑ ❑ <br /> 5 HSC 25510 Failed to report actual or threatened release to the EHD and/or CaIOES Warning Center(V338) o ❑ ❑ <br /> 6 HSC 25508(a)(1) Failed to complete and/or submit the Business Activities or Owner/Operator Identification page(V345) X 0 0 <br /> 7 HSC 25506(a) Failed to complete and/or submit hazardous materials inventory for all.reportable materials on site(V343) 0 0 <br /> 8 HSC 25508.1(a)-(e) Failed to submit revisions to HMBP within 30 days of change in business info or inventory(V346) 0 10 0 <br /> 9 HSC 25508.1(f) Failed to submit revisions to HMBP within 30 days of substantial change in operations(V344) 0 ❑ 0 <br /> 10 HSC 25505(a)(2) Failed to complete and/or submit a site map with all required content(V347) ❑ ❑ <br /> 11 HSC 25505(a)(3) Failed to establish and/or submit emergency response procedures for a release or threatened release I s) ZP ❑ 0 <br /> 12 HSC 25505(a)(4) Failed to submit a training program or program is not reasonable or adequate for facility(V350) ❑ ❑ <br /> 13 HSC 255051 Failed to provide or document initial and/or refresher training to appropriate personnel(V349) 0 0 <br /> 14 HSC 25507.1 Failed to submit emergency response plan when not meeting Ag handier exemption requirements(351) 0 0 0 <br /> 15 HSC 25507.1 Failed to submit training program when not meeting Ag handler exemption requirements(V352) ❑ o ❑ <br /> 16 HSC 25507.2 Failed to establish and implement a HMBP when not meeting remote unstaffed facility exemptions(V353) 0 0 0 <br /> 17 HSC 25511 Failed to submit a written response within 30 days of receiving an inspection report(V808) 0 c ❑ <br /> 1010 See below Unlisted Administration/Documentation violation(V355) 0 ❑ ❑ <br /> 1040 See below Unlisted Release/Leaks/Spills violation(V356) _ _ _ <br /> SUMMARY OF VIOLATIONS <br /> CLASS I,CLASS II or MINOR-Notice to Comply <br /> s°. <br /> S r <br /> ALL EHD STAFF TIME ASSOCIATED WITH FAILING TO COMPLY BY THE ABOVE NOTED DATES WILL BE BILLED AT THE CURRENT HOURLY RATE. <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> Received by(signature): Title: Date: <br /> he -7 (a~t !s <br /> Recery y(prinLted name)- Inspector: Inspector phone <br /> R : <br /> C X1121 T f tU /dc C� AIV r,% LL, -� •S e e cC a�q r153- 68 <br /> EHD 19-01 REV 03/04/15 Page 1 HM INSPECTION REPORT <br />