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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.sicehd.com HAZARDOUS MATERIALS PROGRAM INSPECTION REPORT Facility FacilityInspectio / Name: Phone: Date: Facility /� 1 EPA CERS Address: ✓� ID: ID: Facility Contact Contact during inspection,if Contact: Phone: Z different from facility contact: InspectionQ Program: Type: (f CCR=California Code of Regulations HSC=Health and Safety Code CFR=Code of Federal Regulations V=Violation R=Repeat COS=Corrected on site during inspection Violations _ X'w qe:-.,COS_,: 1 HSC 25507 Failed to establish and implement a hazardous materials business plan(V334) ❑ ❑ ❑ 2 HSC 25508(a)(1) Failed to electronically submit a business plan(V335) ❑ ❑ 3 HSC 25508(c) Failed to annually review and certify that the business plan is complete,accurate,and up to date(V342) ❑ ❑ ❑ 4 HSC 25505.1 Failed to notify property owner that facility is subject to and in compliance with the HMBP program(V341) ❑ ❑ ❑ 5 HSC 25510 Failed to report actual or threatened release to the EHD and/or CaIOES Warning Center(V338) ❑ ❑ ❑ 6 HSC 25508(a)(1) Failed to complete and/or submit the Business Activities or Owner/Operator Identification page(V345) ❑ ❑ 7 HSC 25506(a) Failed to complete and/or submit hazardous materials inventory for all reportable materials on site(V343) a ❑ 8 HSC 25508.1(a)-(e) Failed to submit revisions to HMBP within 30 days of change in business info or inventory(V346) ❑ ❑ ❑ 9 HSC 25508.1(f) Failed to submit revisions to HMBP within 30 days of substantial change in operations(V344) ❑ ❑ ❑ 10 HSC 25505(a)(2) Failed to complete and/or submit a site map with all required content(V347) ❑ ❑ 11 HSC 25505(a)(3) Failed to establish and/or submit emergency response procedures for a release or threatened release M4el jC ❑ ❑ 12 HSC 25505(a)(4) Failed to submit a training program or program is not reasonable or adequate for facility(V350) ❑ ❑ 13 HSC 25505(a)(4) Failed to provide initial and/or refresher training to appropriate personnel(V349) ❑ ❑ 14 HSC 25507.1 Failed to submit emergency response plan when not meeting Ag handler exemption requirements(351) ❑ ❑ ❑ 15 HSC 25507.1 Failed to submit training program when not meeting Ag handler exemption requirements(V352) ❑ ❑ ❑ 16 HSC 25507.2 Failed to establish and implement a HMBP when not meeting remote unstaffed facility exemptions(V353) ❑ ❑ ❑ 17 HSC 25511 Failed to submit a written response within 30 days of receiving an inspection report(V808) ❑ ❑ 0- 1010 See below Unlisted Administration/Documentation violation(V355) ❑ ❑ ❑ 1040 See below Unlisted Release/Leaks/Spills violation(V356) ❑ ❑ ❑ SUMMARY OF VIOLATIONS / ^ - (CLASS I, CLASS 11,or MINOR—Notice to Comply l� a 2 k a c w xi ALL EHD STA TIME ASS CI TED WITH FAILING TO O PLV BY THE AB VE N TED %TES WILL BE BILLED AT THE CURRENT HOURLY RATE. 4 THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. Received by(signature): Title: Date: 0111 Received by(printed name): lnspe:,t,:r U nspector phone: EHD 19-01 REV 10/07/14 Page 1 HM INSPECTION REPORT