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09/11/2003 09: 57 2 9-839P161 BACK ROADS CUSTOM Cy PAGE 04/06 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> SAN JOAQUIN COUNTY <br /> a <br /> 'z* Donna K. crap.R E.I .S. Unr!tSrrDerwirors <br /> w. :< D rector <br /> 304 East Weber Avenue, Third Floor Carl Borgman, <br /> '• Al RDT <br /> Ots s,R.$.H.S. Stockton, California 95202-2708 Mike las W. <br /> Wilson, <br /> R.. .H.S. <br /> Douglas W.VJtlsan,R.E.}i.S. <br /> • off. ��r ProgramManager Telephone: (209) 468-3420 Margaret Lagorio,R.E-11,S. <br /> ii r 6'404 Lourie A.Colulls,ILE.H.S. <br /> Progr m d4anager Fax: (209)464-0138 Robert McClellon,R-B.N.S. <br /> Mark Barcellos,R.E.H-5 <br /> UNIFIED PROGRAM HAZARDOUS WASTE INSPECTION REPORT <br /> Facility Name <br /> Address 121 - <br /> City State CIL Zip Code j;; 4�90 <br /> EPA I.D.Number CA�L� 5_519_- .------Industry Type_ k&w=&�' <br /> Facility Contact W_Title Phone t� <br /> Consent Given By -. .Title <br /> Inspection Date($) ,,._,_._.Inspection Type (circle): Rout/ Complaint Follow-Up <br /> REPRESENTATIVES PRESENT <br /> Name �Title Organization ` r <br /> OIL _ <br /> This report may identify conditions observed this day that are alleged to be violations of one or more sections of the California <br /> Health and Safety Code (H C) or the California Code of Regulations. Tale 72 (22 CCR) relating to the management of <br /> hazardous waste. The violations may be described in more detail on the attached note sheets. After completing the <br /> evaluation of the information Dbtained during the inspection,you may be informed of additional violations. <br /> if any violations are noted, the facility is required to submit a signed Certification of return to Compliance within BO <br /> days, unless otharwise specified(A certification form is provided). <br /> Failure to correct these violations wilbin the scheduled period provided may result In San Joaquin County Environmental <br /> Health Department(EHD) citing you for continuing/additional violations, issuance of this Inspection Report does not preclude <br /> EHL)from taking any administrative,civil or criminal action as a result of the violations noted. <br /> < z <br /> nv ronmental Health Speci list a ived Dae T <br /> 3/5/02 Page 1 of � <br />