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SERVICES , �PUBLIC HEALTH �T <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DMSION _ l <br /> •.�. .P/ <br /> Karen Furst, M.D., M.P.H., Health Officer <br /> 304 East Weber Avenue,Third Floor • Stockton, CA 95202 <br /> 209/468-3420 <br /> UNIFIED PROGRAM HAZARDOUS WASTE INSPECTION REPORT <br /> Facility Name <br /> Address <br /> t <br /> State CA Zip Code <br /> City -P' <br /> EPA I.D.Number C dU� <br /> O <br /> Phone -3 `3 <br /> Facility Contact ts - <br /> CI <br /> Consent Given By <br /> Date(s) G' Inspection Type (circle): outin ' Complaint Follow-Up <br /> Inspection <br /> REPRESENTATIVES PRESENT <br /> Title Or anization <br /> e . <br /> or more s <br /> ections of the <br /> ia <br /> This report may identify conditions observed this day that are alleged to be vioviolations <br /> ti n 22 f one <br /> SC) or the California Code of Regulations, Ti relating to the management P tof <br /> Health and Safety Code (H <br /> tions may be described in more detail on the <br /> hazardous waste. The violaion PHS EHD may inform you of Afterd note sheets. completing the <br /> of additional violations <br /> evaluation of the information obtained during the inspect <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 /> San Jouin <br /> unty <br /> ic <br /> Failure to correct these violations within the scheduled period <br /> contnuing/add tonalroviemay result lviolatonsalssuan�e of thisbinspectiotn <br /> Services-Environmental Health Division (PHS-EHD) citing you for <br /> Report does not preclude PHS-EHD from taking any administrative,civi riminal action as a result of the violations noted. <br /> 4 <br /> "ceived b <br /> 4De <br /> Environmental Health Specialist <br /> e Y <br /> Page 1 of <br /> 12/9/98 <br /> A Division of San Joaquin County Health Care Services <br />