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Environmental Health Qepartmerlt SAKI 1QAQUIN ram Inspection Repo Hazardous Materials prop Date : Facility Phone : Jl C t�f , ? t Facility Name :. / CERS ID ; Facility Address : � � / I G.�—^OM1 Ph� nf� C. /7 Title : Inspe Contact v " / Inspection Type : f ; ,J � � ) Consent Given By : Consent For: Ins ection PhOtOs ❑ Sam IeS CFR = Code of Federal Regulations CCR = Title 19 C Idornia Code of Regulations HSC = Health and Satet � Code v = Violation R = Repeat violation GOS = Corrected on site during ins III ME violations P. V � r COS 1 SJO 4432 Failed to pay annual operating fees V o R 41 COS submit a hazardous materials business plan 2 HSC 25505 , 25508 (a) Failed to complete and electronically su o ( 1 ) � V ❑ R COS Failed to establish and implement a hazardous materials business plan HSC 25501 CS 4 HSC 25508 (a) ( 1 ) 3 � Failed to complete and/or submit the Business Activities or Owner/Operator Identification page V o R PAC OS ❑ R CCS 5 HSC 25505(a) ( 1 ) Failed to complete and/or submit hazardous materials inventory for all reportable materials on site o R COS 5 HSC 25505 (a) (2) Failed to complete and/or submit a site map with all required content 7 HSC 25505 (a) (3 ) Failed to establish and/or submit emergency response procedures for a release or threatened release o V R CCS c ❑ V P, aCOS 8 HSC 25505(a) (4) Failed to submit a training program or program is not reasonable or adequate for facility n 9 HSC 25505(a) (1 ) Failed to annually review and certify that the business plan is complete , accurate , and up to date ❑ V e R COS 10 HSC 25508. 1 (a)-(f) Failed to submit revisions to business plan within 30 days of substantial change in operations o V a R o COS 11 HSC 25505 (a ) (4 ) Failed to provide or document initial and/or refresher training to appropriate personnel ❑ V in R o COS 12 HSC 25505 (c) Failed to have the business plan readily available to facility or EHD personnel o V ❑ R ❑ COS 13 HSC 25505 . 1 Failed to notify property owner that facility is subject to and in compliance with the HMBP program D V ❑ R ❑ COS 14 HSC 25505 . 1 Business on leased property failed to provide copy of HMBP wrin 5 days of request by property owner ❑ V ❑ R ❑ COS 15 HSC 25510(a) Failed to report actual or threatened release to the EHD and/or CalOES Waming Center o V ❑ R o COS 16 HSC 25507 . 1 Failed to submit emergency response plan when not meeting Ag handler exemption requirements V ❑ R COS 17 HSC 25507. 1 Failed to submit training program when not meeting Ag handler exemption requirements V c R , COS 18 HSC 25505 , 25507 . 2 Failed to establish and implement a HMBP when not meeting remote unstaffed facility exemptions ❑ V ❑ R ❑ COS 19 HSC 25404 . 1 . 2 Failed to submit a certification and written response within 30 days for minor violations o V ❑ R COS 20 HSC 25507 , 1 (a ) (2) Failure of Ag handler to post adequate waming signs to meet exemption requirements o V ❑ R ❑ COS 1010 See below Unlisted Administration/Documentation violation o V ❑ R o COS 1020 See below Unlisted Training violation ❑ V ❑ R ❑ COS 1030 See below Unlisted Operations/Maintenance violation ❑ V ❑ R COS 1040 See below Unlisted Release/Leaks/Spills violation ❑ V ❑ R COS 1045 See below Unlisted Release/Leaks/Spills - Local Ordinance ❑ V ❑ R COS 1050 vee below Unlisted Abandonment/Illegal Disposal/Unauthorized Treatment violation e V c R COS 1055 See below Unlisted Abandonment/Illegal Disposal/Unauthorized Treatment - Local Ordinance c \/ �; R ICS FA0009065 PR0519356 SCO03 06i12f2019 EHCJ 19-01 Rev, 09/27/2018 Page 1 of 2 Hazardous Matenals Pra9mm Oii 1868 E , Hazelton Avenue Stockton California 95205 T 209 468- 3420 F 209 454 - 0138 1 www , SjC,ehd . coni M h .