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ENVIRONMENTAL HEALTH DEPARTMENT <br /> rjW4: <br /> SANJOAQUIN COUNTY <br /> Unit Supervisors <br /> iDonna K.Heran, R.E.H.S. Carl Borgman.R.E.H.S. <br /> J04 East Weber Avenue, Third floor.f:< f)irector Mike Humins.R.E.H.S..R.D.I. <br /> -"�' Al Olsen, R.E.H.S. Stockton. California 95202-270$ Douelas w. Wilson.R.E.H.S. <br /> Program Manager Telephone: (209) 468-3420 %largaret La¢ono.R.E.H.S. <br /> Qu o a' Laurie A.Cotulla, R.E.H.S. Fax: (209) 464.0138 Robert 'AcClellon.R.E.H.S. <br /> Program Manager .lark Barcellos.R.E.H.S. <br /> UNIFIED PROGRAM HAZARDOUS WASTE INSPECTION REPORT <br /> Facility Name <br /> Address 3 <br /> City - I State CA-Zip Code 257 0 _ <br /> EPA I.D.Number <br /> q (a Qc'7 � I ndustry Type (-} f�l-�-F � � #--, <br /> �'�,� <br /> Facility Contact Title- E IG LA Phone <br /> Consent Given By Title �—'1f S , <br /> Inspection Date(s) Inspection Type (circle): outine Complaint Follow-Up <br /> REPRESENTATIVES PRESENT <br /> Name <br /> Title Organization <br /> This report may identify conditions observed this day that are alleged to be violations of one or more sections of the California <br /> Health and Safety Code (HSC) or the California Code of Regulations, Title 22 (22 CCR) relating to the management of <br /> hazardous waste. The violations may be described in more detail on the attached note sheets. After completing the <br /> evaluation of the information obtained during the inspection,you may be informed of additional violations. <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 /> Failure to correct these violations within the scheduled period provided may result in San Joaquin County Environmental <br /> Health Department(EHD) citing you for continuing/additional violations. Issuance of this Inspection Report does not preclude <br /> EHD from taking any administrative, civil or criminal action as a result of the violations noted. <br /> noir nme tat Healt Speci ist Received by Date <br /> 3l5i02 Page Z of <br />