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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, California 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sigov.o[g/ehd/unitiii.html <br />CONTINUATION FORM <br />Page: 9 of 9 <br />OFFICIAL INSPECTION REPORT <br />Date: 09/14/11 <br />Facility Address: 107 Val Dervin Pkwy., Stockton <br />Program: HW <br />SUMMARY OF VIOLATIONS <br />CLASS I, CLASS 11, or MINOR -Notice to Comply) <br />812. (continued) <br />record may take the form of a log, invoice, manifest, bill of lading, or other shipping document, and shall <br />include the following: <br />- Name & address of destination facility <br />- Quantity & type of universal waste <br />- Date of departure/shipment <br />Begin this practice immediately. <br />Complete and submit a copy of the Return to Compliance Certification to the EHD by October 14, 2011 <br />along with a statement documenting the corrective actions that have been or will be taken for each <br />violation and any supporting paperwork. <br />*"Facility generated 16.6 tons of hazardous waste in 2010. <br />Provided: <br />- Schedule of FREE classes <br />- Sample hazardous waste label <br />- Small Business Household Hazardous Waste Facility brochure <br />- Return to Compliance Certification form <br />ALL EHD STAFF TIME ASSOCIATED WITH FAILING TO COMPLY BY THE ABOVE NOTED DATES WILL BE BILLED AT THE CURRENT HOURLY RATE. <br />THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br />EHD Inspector: <br />Stacy Rivera (209) 468-344 <br />Recei <br />Title: <br />EHD 23-02-003 Rev 07/12/11 / `J v 0 <br />CONTINUATION FORM <br />