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ENVIRONMENTAL HEALTH DEPARTMENT <br /> SAN JOAQUIN COUNTY Unit Supervisors <br /> o..: <br /> �.• "`�` •;PGCarl Borgman,R.E.H.S. <br /> Donna K.Heran,R.E.H.S. 304 East`Veber Avenue,Third Floor Mike Hudgins,R.E.H.S.,R.D.I. <br /> Director <br /> ' Al Olsen,R.E.H.S. Stockton, California 96202-2708 Doualas W.Wilson,R.E.H.S. <br /> . <br /> Program Manager Telephone: (209) 468-3420 Margaret Lagorio,R.E.H.S. <br /> • oq:• : • Fax: (209) 464-0138 Robert blcClellon,R.E.x.s. <br /> LI F Ow Laurie A.Cotulla,RE.H.S. Mark Barcellos,R.E.H.S. <br /> Program Manager <br /> UNIFIED PROGRAM HAZARDOUS WASTE INSPECTION REPORT <br /> Facility Name <br /> Address aLR: � �� � <br /> �� iio� <br /> State�A Zip Code <br /> City <br /> Industry Type <br /> EPA I.D.Number _ _ <br /> �� <br /> Facility Contact ���-L-��� F ' Title <br /> Phone <br /> Title cA- <br /> Consent Given By <br /> FPS ��-�� <br /> s Inspection Type (circle): E�ipComplaint Follow-Up <br /> ate <br /> Inspection ( ) <br /> REPRESENTATIVES PRESENT <br /> Title Organization <br /> Names <br /> 03�� d� <br /> management o <br /> ti conditions observed this day that are alleged to be Title 22n 22fCCR) relating toone or more tlthe ons of the aliform <br /> This report may <br /> identify ( completing th <br /> Health and Safety Code (HSC) or the California Code of Regulations, <br /> n the attached note <br /> hazardous waste. The violations may be described in .more detail informed of additional violations. comp 9 <br /> evaluation of the information obtained during the inspection,you may trance within 6 <br /> If any violations are noted,the facility is required to submit a signed Certification of Return to Comp <br /> days, unless otherwise specified (A certification form Is p countyEnvironment <br /> Failure to correct these violations within the scheduledReport does not precluc <br /> opaI violations. Issuance of this Inspectionriod provided may result in San Joaquin <br /> Health Department(EHD) citing y continuingladds <br /> you for <br /> EHD from taking any administrative,civil or criminal action as a result of e violations-note . <br /> ecei a by <br /> D to <br /> konmental ealth Specialist <br /> page! of S <br /> 315!02 <br />