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SAN JOAQUIN <br />Environmental Health Department <br />Small Quantity Hazardous Waste Generator Inspection Report <br />Facility Name: <br />Facility Address: <br />1 <br />Date: <br />Dollar General # 15928 <br />12984 Blossom Ct. Lockeford <br />August 09 2019 <br />SUMMARY OF VIOLATIONS <br />(CLASS I, CLASS ll, or MINOR - Notice to Comply) <br />Item # <br />Remarks <br />109 <br />CCR 66262.23(x)(4) Failed to send generator manifest copies to DTSC within 30 days. <br />According to Sue Dean, Assistant Store Manager, manifests received by the facility for the disposal of hazardous <br />waste are kept in a binder in the hazardous waste storage area, and copies of the manifests are not sent or mailed <br />anywhere. The Dollar General Environmental Compliance Program Training, observed on site, also indicated that <br />manifest copies are to be kept in the binder, and did not indicate that manifest copies are sent or mailed anywhere <br />(IMG 8126). <br />Copies of the following manifests numbers were observed on site, but are not on file with DTSC: <br />- 013120710FLE (6/9/19) <br />- 013120709FLE (6/10/19) <br />- 012951288FLE (2/7/19) <br />- 012951287FLE (2/8/19) <br />- 011388698FLE (8/26/18) <br />- 011388699FLE (8/26/18) <br />The generator manifest copy shall be submitted to DTSC for every shipment on a manifest when California is either the <br />generator state or the destination or consignment state. The generator manifest copy shall be mailed to: <br />DTSC Generator Manifests <br />P.O. Box 400 <br />Sacramento, CA 95812-0400 <br />Immediately mail a copy of the manifests listed and ensure that copies of all generator manifests are sent to DTSC <br />within 30 days of shipping hazardous waste. <br />This is a Class II violation. <br />Overall Inspection Comments: <br />Notes: <br />- According to the Dollar General Environmental Compliance Program Training, the Store Manager or designated <br />Key Carrier should not sign any portion of the hazardous waste manifests (IMG 8126). However, employees <br />Domenique Delatorre, Michael Larsen, and Christopher Simas, have signed Box 15 on uniform hazardous waste <br />manifests for the facility. <br />- Hazardous waste manifest 013120750FLE (6/19/19) for Dollar General #13357, 1201 West Main St. Ripon, CA, <br />was observed in the facility's compliance binder. Sue Dean was informed at the time of inspection that this <br />manifest belonged to Dollar General #13357 in Ripon, CA. <br />An inspection checklist was provided to the facility operator on the day of inspection. The EHD has written the <br />complete report which replaces the initial checklist on 8/16/2019. <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, by 9/15/2019. <br />FA0023094 PRO540560 SCO01 08/09/2019 <br />EHD 22-01 Rev. 09/27/2018 Page 6 of 7 Small Quantity Hazardous Waste Generator OR <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />