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GREY DAVIS,Governor <br /> 3 i-EPA DEPARTMENT OF TOXIC SUBSTANCES CONTROL <br /> est os ry <br /> SAN JOAQUIN COUNTY UNIFIED PROGRAM AGENC <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E.WEBER AVENUE,3RD FLOOR <br /> STOCKTON,CA 95202 �� IFOFw <br /> CHECKLIST AND INITIAL VERIFICATION INSPECTION REPORT FOR <br /> Permit by Rule, Conditionally Authorized, and Conditionally Exempt Notifiers <br /> FACILITY NAME: EPA ID NUMBER: <br /> PHYSICAL ADDRESS: PHONE: <br /> FACILITY CONTACT-NAME: INSPECTION DATE: Local# <br /> SIC CODE(S): _-- <br /> NOTIFIED UNIT COUNT: PBR CA CESW CESQT CEL TOTAL <br /> CORRECT UNIT COUNT: PBR CA CESW CESQT CEL TOTAL <br /> This checklist and inspection report identify violations� govided on form DTSC 1772 hazardousonsite treaters of It also covers <br /> operating under an onsite permitting tier. This inspection verifies the information p <br /> generator requirements,although a separate checklist <br /> hed note sheets.The governing hose laws are the Health and Safety Code uirements. A checkmark indicates violation of <br /> the lady,which are explained in more detail on the <br /> (HSC)and Title 22 of the California Code of Regulations(22 CCR). <br /> Generator Standards: <br /> Each inspection agency may use their own generator insVerif cation Inspection, below. <br /> spection, unless serious deficiencies are suspected. <br /> evaluation of each item or document is not conducted ng <br /> theNO <br /> 1. Contingency plan has been prepared (adequately numbers for emergency coordtina ors)municat>.on <br /> system, lists emergency equipment and phone <br /> 2. Written training documents and records prepard for ime limitslcoyees losedhlabelledhcompatibil tyazardous le. <br /> — 3. Meet container management standards (storage tt <br /> inspected weekly, in good condition,with ignitables/reactives 50 feet from property line). <br /> _ 4, Meet tank management standards (either secondary containment or integrity <br /> n ,tegritnassessments,plus <br /> storage time limits, labelled, compatibility, inspected daily, in good <br /> with <br /> ignitables/reactives 50 feet from property line). <br /> _ 5. All wastes are properly identified. <br /> Treatment Items-Facility Wide: (Facility must submit a revised Form <br /> 17 2 to correct errors or Ori Form DTSC 1772 n(Add any new units <br /> _ (. All units under PBR, CA, and CE are properly <br /> with unit sheets or correct tier on the unit sheet.) <br /> _ <br /> 7. All generator identification information on Form DTSC location of all rest. units. <br /> _ g. The submitted plot plan/map adequately shows <br /> the_ 9. There are records documenting compliance with sewer agency pretreatment standards and <br /> industrial waste discharge requirements,where applicable. <br /> For CA or PBR notifiers: <br /> al waste minimization certification. (PBR submit with renewals. <br /> 10. The generator has an annu <br /> Rev 3/5/Oe <br /> Onsite Checklist(A) Page 1 of_ <br />