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S0 JOA U 1 Environmental Health Department <br /> U ; i y <br /> Small Quantity Hazardous Waste Generator Inspection Report <br /> Facility Name: Facility Address: Date: <br /> SAFEWAY STORE 1769 2808 COUNTRY CLUB BLVD, STOCKTON June 16, 2020 <br /> SUMMARY OF VIOLATIONS <br /> (CLASS I,CLASS II,or MINOR-Notice to Comply) <br /> Item# Remarks <br /> Health Department within 30 days. <br /> This is a Class II violation. <br /> 110 CCR 66262.40(a)Failed to keep signed copy of manifests from the designated facility for three years. <br /> OBSERVATION: Designated facility signed copies of the following Uniform Hazardous Waste Manifest(UHWM) <br /> numbers were not found on-site: <br /> -008553873FLE (7/28/2017) <br /> -017478480JJK(6/29/2018) <br /> -018821370JJK(9/17/2018) <br /> -019865774JJK(6/11/2019) <br /> -020590916JJK(9/17/2019) <br /> REGULATION GUIDANCE: A hazardous waste generator shall keep a copy of each manifest signed in <br /> accordance with section 66262.23(a)for three years or until the generator receives a signed copy from the <br /> designated facility which received the waste.This signed copy shall be retained as a record for at least three years <br /> from the date the waste was accepted by the initial transporter. The hazardous waste generator must submit a <br /> copy of the manifest to the California Department of Toxic Substances Control (DTSC)within 60 days if the <br /> destination facility signed manifest copy is not received from the transporter or designated facility. <br /> CORRECTIVE ACTION: Locate a copy of the destination facility signed manifests and send a copy to the San <br /> Joaquin County Environmental Health Department(EHD). If the destination facility signed manifests cannot be <br /> found then send to DTSC a copy of each generator signed manifest and a statement that the designated facility <br /> signed copy was not received by the generator. DTSC address is DTSC Report Repository, Generator Information <br /> Services Section, PO Box 806, Sacramento, CA 95812-0806. Provide a corrective action statement to the EHD <br /> within 30 days. <br /> This is a Class II violation. <br /> FA0012734 PR0538350 SCO01 06/16/2020 <br /> EHD 22-01 Rev.9/20/2019 Page 6 of 9 Small Quantity Hazardous Waste Generator OIR <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />