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PUBLIC HEALTH SEROVICES a�,N <br />P <br />SAN JOAQUIN COUNTY <br />r <br />ENVIRONMENTAL HEALTH DIVISION N :< <br />Ernes M. Fujimoto, M.D., M.P.H., Acting Health Officer <br />445 N. San Joaquin Street • P. O. Box 388 • Stockton, CA 95201-0388 <br />209/468-3420 <br />HAZARDOUS WASTE INSPECTION REPORT <br />Facility Name <br />Address <br />City State CA Zip Code <br />EPA I.D.Number Cid 3C) <br />Facility Contact Phone <br />Consent Given By <br />Inspection Date(s) — _ Inspection Type (circle): Routin Complaint Follow-Up <br />REPRESENTATIVES PRESENT <br />Name Title Organi ation <br />k&, it LLpLIZ <br />This report may identify conditions observed this day that are alleged to be violations of one or more sections of the <br />California Health and Safety Co e (HSC) or the California Code of Regulations, Title 22 (22 CCR) relating to the <br />management of hazardous wast The violations may be described in more detail on the attached note sheets. After <br />completing the evaluation of the Information obtained during the inspection, PHS EHD may Inform you of additional <br />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 to correct these violations within the scheduled period provided may result in San Joaquin County Public Health <br />Services -Environmental Health Division (PHS-EHD) citing you for continuing/additional violations. Issuance of this <br />Inspection Report does not preclude PHS-EHD from taking any administrative, civil or criminal action as a result of the <br />violations noted. <br />Registered Environmental Health Specialist <br />12/9/94 <br />Received by Date <br />Page 1 of 3 <br />A Division of San Joaquin County Health Care Services <br />