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ENVIRONMENTAL HEALTH DEPARTMENT <br /> PQ•U,,IN• C SAN JOAQUIN COUNTY Unit Supervisors <br /> o.•: Carl Borgman,R.E.H.S. <br /> Donna K.Reran,R.E.H.S. 304 East Weber Avenue,Third Floor Mike Huggins,R.E.H.S.,R.D.I. <br /> a:.:.if _ .. a <br /> ul[. ►�' �.� Director Douglas W.Nilson,R.E.H.S. <br /> �_ - : Stockton, California 95202-270 <br /> Al Olsen,R.E.H.S. Margaret Lagorio,R.E.H.S. <br /> '' P• Program Manager Telephone: (209) 468-3420 Robert McClellon,R.E.H.S. <br /> Laurie A.Cotulla,RE.H.S. Fax: (209) 464-0138 Mark Barcellos,R.E.H.S. <br /> Program Manager <br /> UNIFIED PROGRAM HAZARDOUS WASTE INSPECTION REPORT <br /> Facility Name <br /> Address 9 <br /> State QA..Zip Code <br /> City <br /> EPA I.D.Number <br /> Industry Type <br /> � �� <br /> Phone ? <br /> _._Title <br /> �...► <br /> Facility Contact'-e��E _ <br /> Consent Given By <br /> ' X:- . '> Title -p��� <br /> � <br /> Type (circle): omplaint Follow-Up Inspection <br /> Inspection Date(s)�— <br /> REPRESENTATIVES PRESENT <br /> Title Organization <br /> Name �'� <br /> \T <br /> Title 22 22 CCR) relating to the management o <br /> a identify conditions observed this day that are alleged to be violations of one or more sections of the CavorniE <br /> This report m y � or the Califorrna Code of Regulations, <br /> Health and Safety Code (HSC) <br /> hazardous waste. <br /> The violations may be described in.more detail 'on the attached note sheets. .After completing t <br /> obtained during the inspection,you maybe informed of additional violations• <br /> evaluation of the information compliance within 6 <br /> If any violations are noted,the facility is required to submit a signed Certification of Return to <br /> days,unless otherwise specified (A certification form is provided). •n San Joaquin County Environment: <br /> Failure to correct these violations within the scheduled period provided may result i <br /> EHD citing you for continuing/additional violations. issuance <br /> rioted Inspection Report does not precluc <br /> Health Department( ) <br /> EHD from taking any administrative,civil or criminal action as a result of the viotion <br /> �JSpecitalriist <br /> yDate <br /> iron to H <br /> Page 1 of <br /> 3/5102 <br />