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Cal-EPA DEPARTMENT OF TOXIC SUBSTANCES CONTROL PETE WILSON, Governor <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 445 N. SAN JOAQUIN STREET / PO BOX 388 <br /> STOCKTON, CA 95201-0388 <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 /> 28. The appropriate local agency has been notified. HSC 25143.10 <br /> 29. Activities claimed under the onsite recycling exemption are appropriate. HSC 25143.2 et sec. <br /> Releases: 1f there has been a release, provide the following information: number of releases, date(s), type(s) and quantity of <br /> materialstwaste, and the cause(s). Use unit sheet or attach additional pages. <br /> YES <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 onsite treatment units? <br /> _ 31. 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, an unauthorized and/or accidental release to the <br /> environment does not include spills contained within containment systems. <br /> This report may identify conditions observed this date that are alleged to be violations of one or <br /> more sections at the California Health and Safety Code (HSC) or the California Code of Regulations, <br /> Title 22 (22 CCR) relating to the management of hazardous waste. The violations may be described in <br /> more detail on the attached note sheets. If any violations are noted, the facility is required to the submit <br /> a signed Certification of Return to Compliance within 60 days, unless otherwise specified. (A <br /> certification form is provided.) If any corrections are needed to the initial notification, the facility Will <br /> submit a revised notification within 30 days to the Department of Toxic Substances Control with a copy <br /> to the local enforcement agency. <br /> Inspector(s): <br /> Lead Inspector: (n\�, Other Inspector: <br /> Signature: � l �aC oQ�b� Signature: <br /> Print Name: .1n + n Print Name: <br /> Title: Title: <br /> Agency: sOA,, T om;„ Cn . p li s r EHE Agency: <br /> Phone Number: Vl,.q <) Phone Number: <br /> Facility Representative: <br /> Your signature a o g receipt of this report and does not impllIy agreement with the findings. <br /> Signature: AA Print Name: Ic.4r of <br /> Tide:Q�t�tJ /�Ssr.t rauen ✓ f . Date: � — 3O <br /> Onsite Checklist (C) ✓ Page 6' of August 2, 1994 <br />