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SAN" J D�l+ �� I 11411" Environmental Health Department <br /> COUNTY�l <br /> Small Quantity Hazardous Waste Generator Inspection Report <br /> Facility Name: Facility Address: Date: <br /> Dollar Tree#04403 1 125 Lakewood Mall Lodi May 10 2019 <br /> SUMMARY OF VIOLATIONS <br /> (CLASS I,CLASS II,or MINOR-Notice to Comply) <br /> Item# Remarks <br /> Overall Inspection Comments: <br /> An inspection checklist was provided to the facility operator at the time of inspection. The EHD will generate and <br /> provide a complete report to the facility operator. <br /> Complete and submit a copy of the Return to Compliance Certification form to the EHD with a statement <br /> documenting the corrective actions that have been or will be taken for each violation, and any supporting <br /> paperwork, within 30 days of receiving the complete inspection report. <br /> Provided: Modified Contingency Plan template, List of Free CUPA Classes, Return to Compliance Certification <br /> AFTER THE COMPLIANCE DATE, EHD WILL BILL FOR ALL TIME AND ACTIVITIES ASSOCIATED WITH BRINGING THIS <br /> FACILITY BACK INTO COMPLIANCE. <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> Received by: Date: May 10, 2019 Inspector: Inspector Phone: <br /> AGO-7 — Printed Name and Title: ELIANNA FLORIDO, REHS (209)468-0343 <br /> David Rivas, Store Manager <br /> FA0020328 PR0539176 SCO01 05/10/2019 <br /> EHD 22-01 Rev.09/27/2018 Page 4 of 4 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 />