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Environmental Health Department <br />Small Quantity Hazardous Waste Generator Inspection Report <br />Date: <br />August 09, 2019 <br /> Facility Address: <br /> 12984 Blossom Ct, Lockeford <br /> Facility Name: <br /> Dollar General # 15928 <br />SUMMARY OF VIOLATIONS <br />(CLASS I, CLASS II, or MINOR - Notice to Comply) <br />RemarksItem # <br />Overall Inspection Comments: <br />An inspection checklist was provided to the facility operator at the time of inspection. The EHD will generate and <br />provide a complete report to the facility operator. <br />Complete and submit a copy of the Return to Compliance Certification form to the EHD with a statement <br />documenting the corrective actions that have been or will be taken for each violation, and any supporting <br />paperwork, within 30 days of receiving the complete inspection report. <br />Provided: List of Free CUPA Training Classes, Return To Compliance Certification <br />AFTER THE COMPLIANCE DATE, EHD WILL BILL FOR ALL TIME AND ACTIVITIES ASSOCIATED WITH BRINGING THIS <br />FACILITY BACK INTO COMPLIANCE. <br />THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> Received by: Inspector Phone: <br /> (209) 468-0343 ELIANNA FLORIDO, REHS <br /> Inspector:August 09, 2019 Date: <br />Printed Name and Title: <br />Sue Dean, Assistant Store Manager <br />Page 4 of 4 <br />FA0023094 PR0540560 SC001 08/09/2019 <br />EHD 22-01 Rev. 09/27/2018 Small Quantity Hazardous Waste Generator OIR <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com