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0 0 SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, California 95205-6232 Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.siaov.oro/ehd CONTINUATION FORM Page: 5 of 5 OFFICIAL INSPECTION REPORT Date: 04/03/13 Facility Address: USA Gas Station #68154 2500 W. Lodi Ave. Lodi, CA 95240 Program: HW SUMMARY OF VIOLATIONS CLASS I,CLASS II,or MINOR-Notice to Com of the waste generated from the clean up of the March 26, 2013 customer fuel spill. 122, 123, & 124. Manifest number 005772858FLE was found without a signed off copy from the 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 May 3, 2013, submit to the EHD a copy of the signed off copy of the manifest or a copy of the information submitted to DTSC. 812. Employee Elizabeth Chavez stated that the UW lamps were taken by the technician at the end of 2012 but the UW disposal record was not on site. The facility maintenance log indicates that lights were out and that Technician Doug H. was on site October 31, 2012 and November 1, 2012 under work orders 1870042 and 1870044. These work orders nor the disposal record was on site. A UW handler shall keep a record of each shipment of UW sent from the UW handler's facility to another facility. The record may take the form of a log, invoice, manifest, bill of lading or other shipping document. The record for each shipment of UW sent shall include the following information: (1) The name and address of the UW handler or destination facility to which the UW was sent; (2) The quantity [count or weight, consistent with, for example, section 66273.32, subsection (d)] of each type of UW sent (e.g., batteries, thermostats, lamps, electronic devices, CRTs, CRT glass); (3) The date of departure of the shipment of UW. A UW handler shall retain each record for at least three years. Submit a statement and supporting documentation explaining how this waste was managed by May 3, 2013. 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 May 3, 2013. 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. EHD Inspector. Re7hyd By: Title: Aris Cacapit (209) 468-3453 4 EHD 23-02-003 Rev 04/19/12 CONTINUATION FORM