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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.corn <br /> -j�,JJAZARDOUS MATERIALS PROGRAM INSPECTION REPORT.,;'" <br /> Facili ,-r },�( Facility Inspection <br /> b I I ` Phone: Date: <br /> Name: <br /> _ CERS <br /> Facility I ID: <br /> Address: <br /> Inspection �' Title hon01 er <br /> Contact: W1 ' <br /> Inspection Program: ,-r <br /> Type: (� <br /> Consent Given For. Consent Q <br /> D Inspection D Photos D Sampling Given By: (A <br /> CCR=California Code of Regulations HSC=Health and Safety CFR_Viiolation ede2R=gulaon <br /> Repeats COS=Corrected on site during inspection <br /> Violations V R COS <br /> 1 HSC 25507 Failed to establish and implement a hazardous materials business plan(V334) ❑ ❑ ❑ <br /> 2 HSC 25508(a)(1) Failed to electronically submit a business plan(V335) <br /> ❑ ❑ ❑ <br /> 3 HSC 25508.2 Failed to annually review and certify that the business plan is complete,accurate,and up to date(V342) ❑ ❑ ❑ <br /> 4 HSC 25505.1 Failed to notify property owner that facility is subject to and in compliance with the HMBP program(V341) ❑ ❑ ❑ <br /> 5 HSC 25510 Failed to report actual or threatened release to the EHD and/or CaIOES Warning Center(V338) ❑ ❑ ❑ <br /> 6 HSC 25508(a)(1) Failed to complete and/or submit the Business Activities or Owner/Operator Identification page(V345) ❑ ❑ ❑ <br /> 7 HSC 25506(a) Failed to complete and/or submit hazardous materials inventory for all reportable materials on site(V343) ❑ ❑ ❑ <br /> 8 HSC 25508.1(a)-(e) Failed to submit revisions to HMBP within 30 days of change in business info or inventory(V34 <br /> ❑ ❑ ❑ <br /> 9 HSC 25508.1(f) Failed to submit revisions to HMBP within 30 days of substantial change in operations(V344 <br /> ❑ ❑ ❑ <br /> 10 HSC 25505(a)(2) Failed to complete and/or submit a site map with all required content(V347) <br /> ❑ ❑ ❑ <br /> 11 HSC 25505(a)(3) Failed to establish and/or submit emergency response procedures for a release or threatened release iveae7 ❑ ❑ ❑ <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 25505(a)(4) Failed to provide or document initial and/or refresher training to appropriate personnel(V349) <br /> ❑ ❑ ❑ <br /> 14 HSC 25507.1 Failed to submit emergency response plan when not meeting Ag handler exemption requirements(351) ❑ ❑ ❑ <br /> 15 HSC 25507.1 Failed to submit training program when not meeting Ag handler exemption requirements(V352) ❑ ❑ ❑ <br /> 16 HSC 25507.2 Failed to establish and implement a HMBP when not meeting remote unstaffed facility exemptions(V353) ❑ ❑ ❑ <br /> 17 HSC 25511 Failed to submit a written response within 30 days of receiving an inspection report(V808) <br /> ❑ ❑ ❑ <br /> 1010 See below Unlisted Administration/Documentation violation(V355) <br /> ❑ ❑ ❑ <br /> 1040 See below Unlisted Release/Leaks/Spills violation(V356) <br /> ❑ ❑ ❑ <br /> SUMMARY OF VIOLATIONS <br /> (CLASS 1,CLASS II,or MINOR— otice to Compl <br /> ST <br /> ALL�EHDAFF TIME THIS FACILITY IS SUBJECT TONGTOtIONK; 9:0 Iiia vi 6:�:: p6=: LF-Mb DATESWILLBE BILLIEDAT REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATEATE <br /> Recei y(signature): <br /> Title: Date: <br /> v.rn S'4e 6 3a 20( 6 <br /> Receive by(print ame): I pector. Inspector phone: <br /> Yt(j Zvq-q5 -W-tl <br /> EHD 19- 1 REV /23/15 Page 1 HM INSPECTION REPORT <br />