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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.siQov.orq./ehd <br />Small Quantity Hazardous Waste Generator Inspection Report <br />Facility Name: <br />Facility Address: <br />Date: <br />Safeway Fuel Center #1769 <br />2808 COUNTRY CLUB BLVD, STOCKTON <br />January 23, 2017 <br />SUMMARY OF VIOLATIONS <br />(CLASS I, CLASS II, or MINOR - Notice to Comply) <br />Item # <br />Remarks <br />110 <br />CCR 66262.40(a) Failed to keep signed copy of manifests from the designated facility for three years. <br />Manifest 015493058JJK (3-3-2016) was found without a signed off copy from the destination facility. Hazardous <br />waste generators shall retain copies of all manifests signed off by the destination facility on site for three years and <br />have them readily available for review. If the generator did not receive a copy of the manifest with the handwritten <br />signature of the owner or operator of the facility to which the generator's waste was submitted within 60 days of the <br />date the waste was accepted by the initial transporter, the generator shall submit a legible copy of the missing <br />manifest, with some indication that the generator has not received confirmation of delivery. This information shall be <br />submitted to: <br />DTSC Report Repository <br />Generator Information Services Section <br />P.O. Box 806 <br />Sacramento, CA 95812-0806 <br />Immediately locate a copy of the missing manifests or prepare and submit the required information to DTSC. Submit <br />to the EHD a copy of the signed off copy of the manifest or a copy of the information submitted to DTSC. <br />This is a repeat violation, Class ll. <br />Overall Inspection Comments: <br />Routine inspection. <br />Complete and submit a copy of the Return to Compliance Certification form to the EHD with a statement <br />documenting the corrective actions that have been or will be taken for each violation, and any supporting <br />paperwork, by February 23, 2017. <br />AFTER THE COMPLIANCE DATE, EHD WILL BILL FOR ALL TIME AND ACTIVITIES ASSOCIATED WITH BRINGING THIS <br />FACILITY BACK INTO COMPLIANCE. <br />THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br />Received by: <br />Date: January 23, 2017 <br />Inspector: <br />Inspector Phone: <br />o <br />® Printed Name and Title: <br />GARRETT BACKUS, Lead Senior REHS <br />(209) 468-2986 <br />Sandra Harbaugh, Station Manager <br />Page 4 of 4 <br />