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Cal -EPA DEPARTMENT OF TOXIC SUB NCES CONTROL GRAY DAVIS, Governor <br />SAN JOAQUIN COUNTY UNIFIED PROGRAM AGENCY •°"°' T <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />304 E. WEBER AVE. <br />STOCKTON, CA 95202 <br />C[IRORR' <br />CHECKLIST AND INITIAL VERIFICATION INSPECTION REPORT FOR <br />Permit by Rule, Conditionally Authorized, and Conditionally Exempt Notifiers <br />SIGNATURE SHEET <br />OnsiteeRReccy_cling: Only answer if this facility recycles more than 100 kilograms/month of hazardous waste onsite. <br />NO /- <br />2�7/ The appropriate local agency has been notified. HSC 25143.10 <br />_ 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 />_ 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 />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. 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: <br />Signature: <br />Print Name: <br />Title: � ��' �� <br />Agency: %-0.44 u� /► C <br />Phone Number: zov y6.9 <br />Other Inspector: <br />Signature: <br />Print Name: <br />Title: <br />Agency:_ <br />Phone N-wif <br />Facility Representative: <br />Your signature no ledges receipt of this report and does not imply agreement with t�}e findings. <br />Signat&g��—Page <br />Print Name:Titl6: Date: S� -�/ /D �_ — of _ Rev 3/5/02 <br />