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SAN JOAl2UIN COUNTY PUP' 'C HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DvWISION <br /> 304 E. WEBER AVE./ P.O. BOX 388 v <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 Woerams/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 SB14 OR SB1796 and failed to prepare and retain current source <br /> reduction documents, as applicable, and make them available to the inspector within (5) days. <br /> A checklist or plan is required only if annual hazardous waste volume is overr 5,000 kilograms (approximately <br /> 11,000 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 <br /> management of hazardous waste. The violations may be described in more detail on the attached note sheets. If any <br /> violations are noted, the facility is required to the submit a signed Certification of Return to Compliance within 30 days, <br /> unless otherwise specified. (A certification form is provided.) If any corrections are needed to the initial notification, the. <br /> facility will submit a revised notification within 30 days to the Department of To3cic Substances Control with a copy to the <br /> local enforcement agency. DTSC or the local enforcement agency may reinspect, at any time, to verify compliance with this <br /> Notice to Comply. <br /> Inspector(s): <br /> Lead Inspector: Other Insoector: <br /> Signature: Signature: <br /> Print Name: �<, J�V r(8 1 Print Name: <br /> Title: Title: <br /> Agency: S 7L Agency: <br /> Phone Number: 4 f 53 n-3 32 Phone Number: <br /> FacilittRpresentative: <br /> Your aco le ges recei of report and does not imply ogre ent with the ffiin-dings. <br /> SignatPrint Name:`�c,r,,.e S A , ) G Mfic T �1 f . <br /> Title: �Qa Date: 1�1zg (`t 7 <br /> Onsite Checklis (C) Page _-�E5i of June 5, 1995 <br />