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• SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, California 95202-3029 Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.siaov.om/ehd/unitiii.htmi CONTINUATION FORM Page: 5 of 5 OFFICIAL INSPECTION REPORT Date: 09/16/11 Facility Address: Lodi Muni Service Center 1331 S. Ham Ln. Lodi, CA 95240 Program: HW SUMMARY OF VIOLATIONS CLASS I,CLASS 11,or MINOR-Notice to Comply) destination facility. Hazardous waste generators shall retain copies of all manifests signed off by the destination facility on site for three years and have them readily available for review. If the generator did not receive a copy of the manifest with the handwritten signature of the owner or operator of the facility to which the generator's waste was submitted within 60 days of the date the waste was accepted by the initial transporter, the generator shall submit a legible copy of the missing manifest, with some indication that the generator has not received confirmation of delivery. This information shall be submitted to: DTSC Report Repository Generator Information Services Section P.O. Box 806 Sacramento, CA 95812-0806 Immediately locate a copy of the missing manifest or prepare and submit the required information to DTSC. By 10-16-11, submit to the EHD a copy of the signed off copy of the manifest ora copy of the information submitted to DTSC. 122 and 124 are Class II Repeat Violations. 123 is a Minor-Notice to Comply. 126. The EPA ID# CAD981970825 of another business was used on the consolidated manifests from the past three years. All copes of each receipt shall contain all the following information: (A) The name, address, identification number, contact person, and telephone number of the generator, and the signature of the generator or the generator's representative. (B) The date of the shipment. (C) The manifest number. (D) The volume or quantity of each waste stream received, its California and RCRA waste codes, the waste stream type listed in subdivision (c), and its proper shipping description, including the hazardous class and United Nations/North America (UN/NA) identification number, if applicable. (E) The name, address, and identification number of the authorized facility to which the hazardous waste will be transported. (F) The transporter's name, address, and identification number. (G) The driver's signature. (H) A statement, signed by the generator, certifying that the generator has established a program to reduce the volume or quantity and toxicity of the hazardous waste to the degree, as determined by the generator, to be economically practicable. Correct immediately by ensuring that manifests are completed correctly and maintained. Minor-Notice to Comply. Complete and submit a copy of the Return to Compliance Certification form with a statement of how each violation was corrected, including supporting documentation, by 10-16-11. ALL EHD STAFF 71ME 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. EHD Inspector. Ived By: Title: Aris Cacapit (209) 468-3453 faVr'�eC� �SefdlrPs EH0 23-02-003 Rev 07/12111 CONTINUATION FORM