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PUBLIC HEALTH SERVICES <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DMSION <br />Facility Name _ <br />Address <br />City <br />EPA I D Number <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 />3 vo-: <br />rr c�ly <br />r _ <br />0 0 0 / 5� /% <br />State CA Zip Code <br />Facility Contact "' L ' ` l '9� Phone <br />Consent Given By <br />Inspection Date(s) <br />qz��_ �Ilryl <br />Inspection Type (circle) <br />REPRESENTATIVES PRESENT <br />�Oufi <br />)Complaint Follow -Up <br />Name � Title,. Organiza ' n <br />This report may identify conditions observed this day that are alleged to be violations of one or more sections of the California <br />Health and Safety Code (HSC) or the California Code of Regulations, Title 22 (22 CCR) relating to the management of <br />hazardous waste. The violations may be described in more detail on the attached note sheets. After completing the <br />evaluation of the information obtained during the inspection, PHS-EHD may inform you of additional 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 �9 correct these violations within the scheduled period provided may result in San Joaquin County Public Health <br />Servic -Environmental Health Division (PHS-EHD) citing you for continuing/additi al violations. Issuance of this Inspection <br />Repo does not p lude PHS-EHD from taking any a ive, civil or . 'nal tion as a result 4Date <br />noted. <br />b <br />v ronmental Health Specialist R eive by <br />12/9/98 <br />A Division of San Joaquin Counry Hcalth Care Scrviccs <br />Page 1 of _ <br />