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Cal-EPA DEPARTMENT OF TOXIC SUP -ANCES CONTROL GRAY DAVIS,Governor <br /> SAN JOAQUIN COUNTY UNIFIED PROGRAM AGENCY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E. WEBER AVE. <br /> STOCKTON, CA 95202 <br /> ♦ ,w wJ <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 SB 14 OR SB 1796 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,block <br /> diagrams, and implementation schedule of selected source reduction measures. <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 of <br /> 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 or <br /> the local enforcement agency may reinspect,at any time,to verify compliance with this Notice to Comply. <br /> Inspector(s): <br /> Lead Ins a Other Inspector: <br /> Signature: Signature: /N aj.Lgg. <br /> Print Name: Print Name: 4A �ck4-U 2 Le <br /> Title: fL C- 14 ir Title: ^1�4 A Ito„r As C- H S <br /> Agency: £ N D Agency: C- HW <br /> Phone Number: 24M q 6Y 3t4'Si Phone Number: ZOek t((.T qT y7 <br /> Facility Representative: <br /> Your signatur knot edges re eipt of this report and does not imply reemegt with the findings. <br /> Signature: Print Name: Heal <br /> Title: rDate: <br /> Onsite Ch klist C) Page n of Rev 3/5/02 <br />