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Cal -EPA DEPARTMENT OF TOXIC SlI"'�TANCES CONTROL PETE WILSON, Governor <br />SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION ,~ <br />445 N. SAN JOAQUIN STREET / PO 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 oven S, 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 />Signature: , • t ` l <br />Print Nam <br />Title: 1 �� <br />Agency: C? I, 4 S - 1EHO <br />Phone Number: Q. L g- OS3 S— <br />Other Inspector: <br />Signature: <br />Print Name: _ <br />Title: <br />Agency: <br />Phone Number: <br />Facility Representative: <br />Your signs acknowledges receipt of this report and does not imply agreement with the findings. <br />Signature: Print Name: a, <br />Title: oxo Date: C0 I <br />Onsite Checklist (C)� Page 3 of(P June 5, 1995 <br />