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A <br /> PUBLIC HEALTH SERVICES <br /> SAN jOAQUIN COUNTY <br /> EN-VIRONMENTAL HEALTH DMSION n <br /> Karen Furst, M.D., M.P.H., Health Officer <br /> 304 East Weber Avenue, Third Floor • Stockton, CA 95202 <br /> 2091468-3420 <br /> UNIFIED PROGRAM HAZARDOUS WASTE INSPECTION REPORT <br /> Facility lit Name T <br /> Address Ad 1 <br /> t State CA Zip Code ' " <br /> City t <br /> EPA I.D.Number �~ <br /> Facility Contact <br /> Phone <br /> Consent Given By <br /> Inspection Dates)_ <br /> "20-- S Inspection Type (circle): CoufiDne Complaint Follow-Up <br /> REPRESENTATIVES PRESENT <br /> Nam Xtl <br /> e �� Org niz tion v <br /> he <br /> ia <br /> This report may identify conditions observed this day that are alleged to ,Title`22 n22 fCCRor elating to the managementnof <br /> Th p <br /> Health and Safety Code (NSC) or the California Code of Regulations, <br /> hazardous waste- The violations may be described in more detail on the PHS EHD may inform you additional sheets. <br /> ter completing the <br /> evaluation of the information obtained during the inspection, <br /> If any violations are noted, the facility is required to submit a signed Certification of Return to Compliance within 60 <br /> days, unless otherwise specified (A certification form is provided). <br /> uin <br /> unty <br /> lic Health <br /> Failure to correct these violations within the scheduled period provided may ©nal��ia ationsSan a9ssuanoe of this bInspection <br /> Services-Environmental Health Division (PHS-EHD} citing you for contr g iminal ia�f`on a result of the violations noted. <br /> Report does not preclude PHS-EHD from taking any administrative,c <br /> Ron Marder <br /> (/ Rece- Service Manager <br /> Environmental Health Specialist rower Park Marine <br /> Services <br /> 1219!98 14900 W. Highway 12 <br /> t..r-✓-.rrrrrrrrrrrr <br /> TOWER PARK RF90RT Lodi,CA 95242 <br /> o (209)369-1301 <br /> A Division of San Joaquin Counrl <br /> (209)369-1379(FAX) <br />