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fflo mob � W-1kfe I <br />Facility Name <br />Address / <br />Ernest M. Fujimoto, M.D., M.P.H., Acting Health Officer <br />304 E.Weber Ave., 3rd Floor • P. O. Box 388 • Stockton, CA 95201-0388 <br />209/468-3420 <br />City G State CA Zip Code _ <br />-:PA I.D.Number <br />Facility Contact�Phone <br />y " <br />Aj"EAV 'e <br />Consent Given By <br />�J <br />0 <br />Inspection Date(s) / J Inspection Type (circle Routine Complaint Follow -Up <br />E MR <br />Organization <br />1 <br />S o ra <br />This report may identify conditions observed this day that are alleged to be violations of one or more sections of the <br />California Health and Safety Code (HSC) or the California Code of Regulations, Title 22 (22 CCR) relating to the <br />management of hazardous waste. The violations may be described in more detail on the attached note sheets. After <br />completing the evaluation of the information obtained during the inspection, PHS-EHD may inform you of additional <br />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 Public Health <br />Services -Environmental Health Division (PHS-EHD) citing you for continuing/additional violations. Issuance of this <br />Inspection Report does not preclude PHS-EHD from taking any administrative, civil or criminal action as a result of the <br />violations noted. <br />Registered Environmental Health Specialist Received 43y Date <br />12/9/94 Page 1 of <br />A Division of San Joaquin County Health Care Services <br />