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Cal -EPA DEPARTMENT OF TOXIC SUMMANCES CONTROL Edmund G. Brown, Jr., Governor <br />Wr <br />SAN JOAQUIN COUNTY UNIFIED PROGRAM AGENCY ►>h <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 E MAIN ST. _ ' <br />STOCKTON, CA 95202-3029 <br />NO ' <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 SB14 OR SB1796 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, lock <br />diagrams, and impleme to io sph dule of selected source reduction measures. <br />Y,33. �4SL 2- 1 - (G l2� - 1r►4s w�ri�, w9'�`�. (,,� gty�Ma�S Ar�.ro1S �,�j��l�'' <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 <br />of 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 <br />or 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: ISI/ Signature: <br />Print Name: Tc 'r -yo v Print Name:R4-f"&40 Vdri "--- <br />Title: r 4Z (5 -AA S Title: Le*b <br />Agency: g S C G --H 1D Agency: G <br />Phone Number: 4.611 - O 33.5 Phone Number: ' (46 9- 4bLit <br />Facility Representati mpl ement <br />Your si t e es rete' 's report and does not iagr with he findings. <br />Signa e: Print Name: % �C�k� -r2' l� <br />Title: Date• <br />C "IO ite Checklist (C) Page .3 of _ <br />