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Cal-EPA DEPARTMENT OF TOXIC SU6..rANCES 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 /> 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 /> V" 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. A <br /> checklist or plan is required only ifannual 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 Inspector: Other Inspector: <br /> Signature: A(�)J.oUJ—-k� Signature: <br /> Print Name: M-C=cl It Jae, Print Name: Oetig 5Cot" et <br /> Title: Ce Ai e z ZC&I 5 h Title: Q 9' H 5 - <br /> Agency: C'U'r4rt Agency: fliaranr.-th,(&t fl-& k 9t Pd' <br /> Phone Number: ybY-4 r Y 7 Phone Number: 1017 46 f-TYS-q <br /> Facility Representative: <br /> Your signature act I wledges receipt of this report and does not imply agreement with the findings. <br /> Signature. �ira Print Name: / 2=Z.2-Am...r oo Al <br /> Title: � �, .«� flr, i7' Date: i -0 -a <br /> Onsite Checklist (C) Page of Rev 3/5/0 <br />