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PUBLIC tEALTH SERV'iOCES <br />SAN JOAQUIN COUNTY <br />E VIRONMENTAL HEALTH DIVISION <br />Ernest M Fujimoto, M.D., M.P.H., Acting Health Officer <br />445 , .San oaquin Street • P.O. Box 388 • Stockton, CA 95201-0388 <br />(209) 468-3420 <br />HAZARDOUS WASTE INSPECTION REPORT <br />Facility Name <br />Address -2 <br />City <br />EPA I.D.Number,,,,- <br />Facility <br />umberGFacility Contact <br />Consent Given By <br />Inspection Date(s) <br />Name <br />State CA Zip Code <br />Phone <br />Inspection Type (circle)• outin Complaint Follow -Up <br />REPRESENTATIVES PRESENT <br />Title Organization <br />d 3 �6n- <br />�{ p e <br />U,01e-/L- �UZ- Z7/-ZZ3S- <br />v76J <br />This report may identify conditio s observed this day that are alleged to be violations of one or more sections of the <br />California Health and Safety C de (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 th information obtained during the inspection, PHS-EHD may inform you of additional <br />violations. <br />If any violations are noted, the f cility is required to submit a signed Certification of Return to Compliance within 60 <br />days, unless otherwise specifie (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 ivision (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 <br />A Dixi.ion o1San Joaquin Couut% Health Care ticnicc, <br />Date <br />Page 1 of 1 <br />