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Ltd-EPA DEPARTMENT OF TOXIC SUBSTANCES CONTROL GRAY DAVIS.Governor <br /> SAN JOAQUIN COUNTY UNIFIED PROGRAM AGENCY °` T <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> W <br /> 304 E.WEBER AVE. <br /> STOCKTON,CA 95202 <br /> C�(IR0a <br /> CHECKLIST AND INITIAL VERIFICATION INSPECTION REPORT FOR <br /> Permit by Rule, Conditionally Authorized, and Conditionally Exempt Notifiers <br /> r SIGNATURE SHEET <br /> this facility recles <br /> bIISite Recycling: Only answer if more than 100 kilograms/month of ha;ardous waste onsite. <br /> NO <br /> _ 27. The appropriate local agency has been notified. HSC 25143.10 <br /> _ 28.':, Activities claimed under the onsite recycling exemption are appropriate. HSC 25143.2 et sec. <br /> Releases: <br /> YES <br /> _ 29 Within the last three years, were there any unauthorized or accidental releases to the <br /> dous waste constituents from onsite treatment units? <br /> environment of hazardous waste or hazar <br /> _ <br /> 30-! Within the last three years, were there any unauthorized or accidental releases to the <br /> environment of hazardous waste or hazardous waste constituents from any location at this, <br /> facility? <br /> For purposes of a Tiered Permitting inspection, a release to the environment is unauthorized or <br /> accidental and does not include spills contained within containment systems. <br /> Source Reduction: <br /> _ 31. Generator was subject to SB 14 OR SB 1796 and failed to prepare and retain current source <br /> reduction documents, as applicable, and make them available to the inspector within(5) days. A <br /> checklist or plan is required only if annual hazardous waste volume is overr 5,000 kilograms(approximately 11,000 <br /> pounds or 1,350 gallons). <br /> _ 32. Source Reduction Evaluation Review and Plan failed to contain, at a minimum, the following <br /> five required elements: certification, amounts of wastes generated,process description,block <br /> diagrams, and implementation schedule of selected source reduction measures. <br /> This report may identify conditions observed this date that are alleged to be violations of one or more sections of the <br /> California Health and Safety Code(HSC)or the California Code of Regulations,Title 22(22 CCR)relating to the management of <br /> hazardous waste. The violations may be described in more detail on the attached note sheets. If any violations are noted,the <br /> facility is required to submit a signed Certification of Return to Compliance within 30 days,unless otherwise specified. (A <br /> certification form is provided.)If any corrections are needed to the initial notification,the facility will submit a revised <br /> notification within 30 days to the Department of Toxic Substances Control with a copy to the local enforcement agency.DISC or <br /> the local enforcement agency may reinspect,at any time,to verify compliance with this Notice to Comply. <br /> Inspector(s): <br /> Lead Inspector: Other Inspector: <br /> Signature: Signature: <br /> Print Name: <br /> Print Name: <br /> Title: Title: <br /> Agency: Agency: <br /> Phone Number: Phone Number: <br /> Facility Representative: <br /> Your signature acknowledges receipt of this report and does not imply agreement with the findings. <br /> Signature: Print Name: <br /> Title: Date: <br /> Page-of_ Rev 3/5/02 <br /> Onsite Checklist(C) g <br />