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Cal .EPA DEPARTMENT OF TOXIC SUBSTANCES CONTROL PETE WILSON, Governor <br />SAN JOAQUIN COUNTY PUBLIC ..EALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />304 E. WEBER AVE. / P.O. BOX 388 <br />STOCKTON, CA 95201-0388 •' <br />CHECKLIST AND INITIAL VERIFICATION INSPECTION REPORT FOR <br />Permit by Rule, Conditionally Authorized, and Conditionally Exempt Notifiers <br />SIGNATURE SHEET <br />Onsite Recycling: Only answer if this facility recycles more than 100 kilograms/month of hazardous waste onsite. <br />NO <br />27. The appropriate local agency has been notified. HSC 25143.10 <br />_ 28. Activities claimed under the onsite recycling exemption are appropriate. HSC 25143.2 et sec. <br />Releases: <br />YES <br />29. Within the last three years, were there any unauthorized or accidental releases to the <br />environment of hazardous waste or hazardous waste constituents from onsite treatment units? <br />30. Within the last three years, were there any unauthorized or accidental releases to the <br />environment of hazardous waste or hazardous waste constituents from any location at this <br />facility? <br />For purposes of a Tiered Permitting inspection, a release to the environment is unauthorized or <br />accidental and does not include spills contained within containment systems. <br />Source Reduction: <br />31. Generator was subject to SB14 OR SB1796 and failed to prepare and retain current source <br />reduction documents, as applicable, and make them available to the inspector within (5) days. <br />A checklist or plan is required only if annual hazardous waste volume is overr 5, 000 kilograms (approximately <br />11, 000 pounds or 1, 350 gallons) . <br />32. Source Reduction Evaluation Review and Plan failed to contain, at a minimum, the following <br />five required elements: certification, amounts of wastes generated, process description, block <br />diagrams, and implementation schedule of selected source reduction measures. <br />This report may identify conditions observed this date 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. If any <br />violations are noted, the facility is required to the submit a signed Certification of Return to Compliance within 30 days, <br />unless otherwise specified. (A certification form is provided.) If any corrections are needed to the initial notification, the <br />facility will submit a revised notification within 30 days to the Department of Toxic Substances Control with a copy to the <br />local enforcement agency. DTSC or the local enforcement agency may reinspect, at any time, to verify compliance with this <br />Notice to Comply. <br />Inspector(s): <br />Lead Ins ector: <br />Signature: <br />Print Name:a <br />Title: <br />Agency: <br />Phone Number: 2`U9 �CoB-Q33.{� <br />Other Inspector: <br />Signature: <br />Print Name: _ <br />Title: <br />Agency: <br />Phone Number: <br />Facility Representative: <br />Your Signa ime acknowledges receipt of this report and does not imply agreement with the findings. <br />Signature: Print Name:,.L�4<:A' <br />Title:.„�,; ys�, .�.1., �,,, ,,� Date: <br />Onsite Checklist (C) Page 5 of S June 5, 1995 <br />