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Cal -EPA DEPARTMENT OF TOXIC <br />ANCES CONTROL <br />GRAY DAVIS, Governor <br />SAN JOAQUIN COUNTY UNIFIED PROGRAM AGENCY •°"`" <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />304 E. WEBER AVE. <br />STOCKTON, CA 95202 <br />C'l IFOM" <br />CHECKLIST AND INITIAL VERIFICATION INSPECTION REPORT FOR <br />Permit by Rule, Conditionally Authorized, and Conditionally Exempt Notifiers <br />SIGNATURE SHEET <br />Onsite Recycling: Only answer if this facility recycles more than 100 kilograms/month of hazardous 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 />environment of hazardous waste or hazardous waste constituents from onsite treatment units? <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). g the following <br />_ 32. Source Reduction Evaluation Review and Plan failed to contain, at a minimum, <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. DTSC 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- �e6-, cw✓KsoH Print Name: L0 c r Wilson <br />Title: S�a��' ,eells Title: S`OV4?�­ <br />Agency:.$:9-G 55,14D Agency: SSG EN D <br />Phone Number: 969-34(510 Phone Number: y68 f 1/' <br />Facility Representative: <br />Your signature c o ledges receipt of this report and does not im ly agreement with the findings. <br />Signature: *Print Name: ' �—' <br />/L lis *Date: CUA- n <br />Title: Rev 3/5/02 <br />Onsite Checklist (C) Page T of — <br />