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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, Califomia 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sicehd.com <br />EHD 19-01 REV 07128/16 Page 1 HM INSPECTION REPORT <br />HAZARDOUS MATERIALS PROGRAM INSPECTION REPORT <br />FacilityFacility <br />Name: Ta, <br />C-. <br />Phoneb-a9 492-6(674- <br />Inspection <br />Date: &I <br />Facility <br />Address: <br />-Z,o 6 <br />CERS <br />ID: <br />Inspection <br />Contact Q�.µ <br />r N <br />Title:Phone: <br />Oras ti <br />tog <br />99'2-667 <br />Ins Program: <br />Type: .—. s I Z <br />Consent Given For. Consent <br />nspection Whotos ❑ Sampling Given By: a� o N <br />CCR = California Code of Regulations HSC = Health and Safety Code CFR = Code of Federal Regulations SJO = San Joaquin County Ordinance <br />V = Violation R = Repeat COS = Com on site during inspection <br />Violations <br />V R <br />COS <br />1 SJO 4432 <br />Failed to pay annual operating fees (V851) <br />❑ ❑ <br />❑ <br />2 HSC 25508 25505, <br />05 <br />Failed to complete and electronically submit a hazardous materials business plan (V335) <br />�[ ❑ <br />❑ <br />3 HSC 25507 <br />Failed to establish and implement a hazardous materials business plan (V334) <br />❑ <br />❑ <br />4 HSC 25508(a)(1) <br />Failed to complete and/or submit the Business Activities or Owner/Operator Identification page (V345) <br />1( ❑ <br />❑ <br />5 HSC 25506(a) <br />Failed to complete and/or submit hazardous materials inventory for all reportable materials on site (V343) <br />DC ❑ <br />❑ <br />6 HSC 25505(a)(3) <br />Failed to complete and/or submit a site map with all required content (V347) <br />piL ❑ <br />❑ <br />7 HSC 25505(a)(3) <br />Failed to establish and/or submit emergency response procedures for a release or threatened release ware) <br />p[ ❑ <br />❑ <br />8 HSC 25505(a)(4) <br />Failed to submit a training program or program Is not reasonable or adequate for facility (V350) <br />j>( ❑ <br />❑ <br />9 HSC 25508.2 <br />Failed to annually review and certify that the business plan is complete, accurate, and up to date (V342) <br />❑ <br />❑ <br />10 HSC 25508.1(a-0 <br />Failed to submit revisions to HMBP within 30 days of substantial change in operations (V346) <br />❑ ❑ <br />❑ <br />11 HSC 25505(a)(4) <br />Failed to provide or document initial and/or refresher training to appropriate personnel (V349) <br />❑ ❑ <br />❑ <br />12 HSC 25505(c) <br />Failed to have the business plan readily available to facility or EHD personnel (V850) <br />�[ ❑ <br />❑ <br />13 HSC 25505.1 <br />Failed to notify property owner that facility is subject to and in compliance with the HMBP program (V341) <br />❑ ❑ <br />❑ <br />14 HSC 25510 <br />Failed to report actual or threatened release to the EHD and/or CaIOES Wanting Center (V338) <br />❑ ❑ <br />❑ <br />15 HSC 25507.1 <br />Failed to submit emergency response plan when not meeting Ag handler exemption requirements (351) <br />❑ ❑ <br />❑ <br />16 HSC 25507.1 <br />Failed to submit training program when not meeting Ag handler exemption requirements (V352) <br />❑ ❑ <br />❑ <br />17 HSC 25507.2 <br />Failed to establish and Implement a HMBP when not meeting remote unstaffed facility exemptions (V353) <br />❑ ❑ <br />❑ <br />18 HSC 25511 <br />Failed to submit a written response within 30 days of receiving an inspection report (V808) <br />o ❑ <br />❑ <br />1010 See below <br />Unlisted AdministratioNDocumentation violation (V355) <br />❑ ❑ <br />❑ <br />1040 See below <br />Unlisted Release/Leaks/Spills violation (V356) <br />❑ ❑ <br />o <br />SUMMARY OF VIOLATIONS <br />CLASS 1, CLASS II or MINOR — Notice to Comply <br />Q-.# 0.14 <br />0,114A04-A.t I` Ij It s ; Cb v, <br />a wk T I& J5a v• +- <br />a o <br />Cc r �r ✓ o✓ t J r �� 4 dOd ' <br />If <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 ANYTIME AT EHD'S CURRENT HOURLY RATE. <br />Received by (signature): <br />�� <br />Tits: y� <br />Date: Lk <br />Received by (printed name): <br />J )-'4W)/aT-C <br />Inspector. <br />Ro6v1- <br />Inspector phone: <br />12�9 lS3- (-2/4 <br />EHD 19-01 REV 07128/16 Page 1 HM INSPECTION REPORT <br />