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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sogov.org/ehd <br /> CONTINUATION FORM Page: 5 of 5 <br /> OFFICIAL INSPECTION REPORT Date: 02/19/14 <br /> Facility Address: 4627 D Vinci Dr., Stockton Program: HW <br /> SUMMARY OF VIOLATIONS <br /> (CLASS I,CLASS II,or MINOR-Notice to Comply) <br /> 812. Copies of universal w ste disposal records were not found on site. A generator of universal waste <br /> (batteries, mercury containing equipment, lamps/bulbs, electronic devices, CRTs, CRT glass, aerosol <br /> cans) shall keep a record Of each shipment of universal waste on site for at least three years. The <br /> record may take the form f a log, invoice, manifest, bill of lading, or other shipping document, and shall <br /> include the following: <br /> - Name & address of d stination facility <br /> - Quantity & type of uni ersal waste <br /> - Date of departure/ship ent <br /> Begin this practice immedi tely. <br /> Complete and submit a co y of the Return to Compliance Certification to the EHD by March 21, 2014 <br /> along with a statement doc menting the corrective actions that have been or will be taken for each <br /> violation and any supportin paperwork. <br /> Provided: <br /> - Return to Compliance Ce ification form <br /> - Modified Contingency Plar template <br /> ALL EHD STAFF TIME ASSOCIATED WITH FAILING TO COMPLY BY THE ABOVE NOTED DATES WILL BE BILLED AT THE CURRENT HOURLY RATE. <br /> THIS FACILITY IS SUB ECT TO REINSPECTION AT ANX TIME AT EHD'S CURRENT HOURLY RATE. <br /> EHD Inspector: Received By: Title: <br /> Stacy Rivera (209) 468-3140 <br /> EHD 23-02-003 Rev 04/19/12 CONTINUATION FORM <br />