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SAN" J D�l+ �� I 1411" Environmental Health Department COUNTY�l Small Quantity Hazardous Waste Generator Inspection Report Facility Name: Facility Address: Date: Dollar Tree#04403 1 125 Lakewood Mall Lodi May 10 2019 SUMMARY OF VIOLATIONS (CLASS I,CLASS II,or MINOR-Notice to Comply) Item# Remarks 109 CCR 66262.23(a)(4) Failed to send generator manifest copies to DTSC within 30 days. According to David Rivas, store manager, manifests received by the facility for the disposal of hazardous waste are kept in a file folder in the facility office, and a copy of the manifests are not sent or mailed anywhere. Generator copies of the following manifests numbers were observed on site, but are not on file with DTSC: -010788644FLE (10/26/17)(IMG 6325) -012039617FLE (9/7/18)(IMG 6323) -012039616FLE (9/7/18)(IMG 6324) -012497924FLE (1/28/19)(IMG 6320) The generator manifest copy shall be submitted to DTSC for every shipment on a manifest when California is either the generator state or the destination or consignment state. The generator manifest copy shall be mailed to: DTSC Generator Manifests P.O. Box 400 Sacramento, CA 95812-0400 Immediately mail a copy of the manifests listed and ensure that copies of all generator manifests are sent to DTSC within 30 days of shipping hazardous waste. This is a Class II violation. 110 CCR 66262.40(a) Failed to keep signed copy of manifests from the designated facility for three years. The following manifest numbers were found without a signed off copy from the destination facility: -009155878FLE (8/10/2016)(IMG 6328-9) -010788644FLE (10/26/17)(IMG 6325) Hazardous waste generators shall retain copies of all manifests signed off by the destination facility on site for three years and have them readily available for review. If the generator did not receive a copy of the manifest with the handwritten signature of the owner or operator of the facility to which the generator's waste was submitted within 60 days of the date the waste was accepted by the initial transporter, the generator shall submit a legible copy of the missing manifest,with some indication that the generator has not received confirmation of delivery. This information shall be submitted to: DTSC Report Repository Generator Information Services Section P.O. Box 806 Sacramento, CA 95812-0806 Immediately locate a copy of the missing manifests or prepare and submit the required information to DTSC. Submit to the EHD a copy of the signed off copy of the manifests or a copy of the information submitted to DTSC. This is a Class II violation. FA0020328 PRO539176 SCO01 05/10/2019 EHD 22-01 Rev.09/27/2018 Page 9 of 15 Small Quantity Hazardous Waste Generator OIR 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com