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Cal-EPA DEPARTMENT OF TOXIC IBSTANCES CONTROL PETE WILSON, Governor SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 445 N. SAN JOAQUIN STREET I PO BOX 388 STOCKTON, CA 95201-0388 (a CHECKLIST AND INITIAL VERIFICATION INSPECTION REPORT FOR Permit by Rule, Conditionally Authorized, and Conditionally Exempt Notifiers SIGNATURE SHEET Onsite Recycling: Only answer if this facility recycles more than 100 kilograms/month of hazardous waste onsite. NO 27. The appropriate local agency has been notified. HSC 25143.10 _ 28. Activities claimed under the onsite recycling exemption are appropriate. HSC 25143.2 et sec. Releases: YES 29. Within the last three years, were there any unauthorized or accidental releases to the environment of hazardous waste or hazardous waste constituents from onsite treatment units? _ 30. Within the last three years, were there any unauthorized or accidental releases to the environment of hazardous waste or hazardous waste constituents from any location at this facility? For purposes of a Tiered Permitting inspection, a release to the environment is unauthorized or accidental and does not include spills contained within containment systems. Source Reduction: 31. Generator was subject to SB14 OR SB1796 and failed to prepare and retain current source reduction documents, as applicable, and make them available to the inspector within (5) days. A checklist or plan is required only if annual hazardous waste volume is overr 5,000 kilograms (approximately 11,000 pounds or 1,350 gallons). 32. Source Reduction Evaluation Review and Plan failed to contain, at a minimum, the following five required elements: certification, amounts of wastes generated, process description, block diagrams, and implementation schedule of selected source reduction measures. This report may identify conditions observed this date that are alleged to be violations of one or more sections of the California Health and Safety Code (HSC) or the California Code of Regulations, Title 22 (22 CCR) relating to the management of hazardous waste. The violations may be described in more detail on the attached note sheets. If any violations are noted, the facility is required to the submit a signed Certification of Return to Compliance within 30 days, unless otherwise specified. (A certification form is provided.) If any corrections are needed to the initial notification, the I facility will submit a revised notification within 30 days to the Department of Toxic Substances Control with a copy to the local enforcement agency. DTSC or the local enforcement agency may reinspect, at any time, to verify compliance with this Notice to Comply. Inspector(s): Lead Inspector: Other Ins ecto � Signature:�Q4�� k�in.,, Signator - 61z s Print Name: �� -kqy, I Print Name: 5- Title: Title: _ H S Title: AgencyE�pAgency: Phone Number: Phone Number: Facility Representative: Your signator acknowledg r eipt of this report and does not imply agreement with the findings. Signator . e 3 �. Print Name: e�w_ Title: Date: �1-7`gS Onsite Checklist (C) Page -3 of s June 5, 1995