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f •1 ' r <br /> PUBLIC HEALTH SERVICES <br /> SAN JOAQUIN COUNTY =' <br /> ENVIRONMENTAL HEALTH DMSION <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 /> I <br /> Address 3Y <br /> City �-� <br /> State CA Zip Code <br /> EPA I.D.Number 1 u <br /> j <br /> Facility Contact l� � (ti Phone <br /> Consent Given By <br /> Inspection Date(s) <br /> Inspection Type (circle): ou ine- Complaint Follow-Up <br /> REPRESENTATIVES PRESENT <br /> N me Title Organization <br /> C_ a 1111. a <br /> v <br /> This report may identify conditions observed this day that are alleged to be vioviolations <br /> ti n22f one or more relating to the of the Californiametof <br /> Health and Safety Code (HSC) or the California Code of Regulations, T <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 /> uin <br /> unty <br /> lic <br /> Failure to correct these violations withinthe PHS-EHDdcitin you foperiod r onitnuing/add tionalmay result ln San violations.alssuan�e of thisbnspectiotn <br /> Services-Environmental Health Division ( ) 9 <br /> Report does not preclude PHS-EHD from taking any administrative,civil or criminal action as a result of the violations noted. <br /> 4Enironm_e(ntaI Hea h Specialist <br /> Received by, Date <br /> Page 1 of <br /> 12/9/98 <br /> A Division of San Joaquin Counry Health Care Services <br />