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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, California 95205-6232 Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjcehd.com Received by (signature): Title: Date: Received by (printed name): Inspector: Inspector phone: EHD 19-01 REV 07/28/16 Page 1 HM INSPECTION REPORT HAZARDOUS MATERIALS PROGRAM INSPECTION REPORT Facility Name: Facility Phone: Inspection Date: Facility Address: CERS ID: Inspection Contact: Title: Phone: Inspection Type: Program: Consent Given For: □ Inspection □ Photos □ Sampling Consent Given By: CCR = California Code of Regulations HSC = Health and Safety Code CFR = Code of Federal Regulations SJO = San Joaquin County Ordinance V = Violation R = Repeat COS = Corrected on site during inspection Violations V R COS 1 SJO 4432 Failed to pay annual operating fees (V851) □ □ □ 2 HSC 25505, 25508(a)(1) Failed to complete and electronically submit a hazardous materials business plan (V335) □ □ □ 3 HSC 25507 Failed to establish and implement a hazardous materials business plan (V334) □ □ □ 4 HSC 25508(a)(1) Failed to complete and/or submit the Business Activities or Owner/Operator Identification page (V345) □ □ □ 5 HSC 25506(a) Failed to complete and/or submit hazardous materials inventory for all reportable materials on site (V343) □ □ □ 6 HSC 25505(a)(3) Failed to complete and/or submit a site map with all required content (V347) □ □ □ 7 HSC 25505(a)(3) Failed to establish and/or submit emergency response procedures for a release or threatened release (V348) □ □ □ 8 HSC 25505(a)(4) Failed to submit a training program or program is not reasonable or adequate for facility (V350) □ □ □ 9 HSC 25508.2 Failed to annually review and certify that the business plan is complete, accurate, and up to date (V342) □ □ □ 10 HSC 25508.1(a-f) Failed to submit revisions to HMBP within 30 days of substantial change in operations (V346) □ □ □ 11 HSC 25505(a)(4) Failed to provide or document initial and/or refresher training to appropriate personnel (V349) □ □ □ 12 HSC 25505(c) Failed to have the business plan readily available to facility or EHD personnel (V850) □ □ □ 13 HSC 25505.1 Failed to notify property owner that facility is subject to and in compliance with the HMBP program (V341) □ □ □ 14 HSC 25510 Failed to report actual or threatened release to the EHD and/or CalOES Warning Center (V338) □ □ □ 15 HSC 25507.1 Failed to submit emergency response plan when not meeting Ag handler exemption requirements (351) □ □ □ 16 HSC 25507.1 Failed to submit training program when not meeting Ag handler exemption requirements (V352) □ □ □ 17 HSC 25507.2 Failed to establish and implement a HMBP when not meeting remote unstaffed facility exemptions (V353) □ □ □ 1010 See below Unlisted Administration/Documentation violation (V355) □ □ □ 1040 See below Unlisted Release/Leaks/Spills violation (V356) □ □ □ SUMMARY OF VIOLATIONS (CLASS I, CLASS II, or MINOR – Notice to Comply ALL EHD STAFF TIME ASSOCIATED WITH FAILING TO COMPLY BY THE ABOVE NOTED DATES WILL BE BILLED AT THE CURRENT HOURLY RATE. THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD’S CURRENT HOURLY RATE.