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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, California 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjcehd.com <br />EHD 19-01 REV 07/28/16 rage i ���� ������� � ���� � ��� �� <br />HAZARDOUS MATERIALS PROGRAM INSPECTION REPORT <br />V <br />Facility <br />Name: <br />/� n ���?f�'Oy1 <br />f"t j21� <br />Facility <br />Phone:Zl�%—���0��� <br />SJO 4432 <br />q <br />Inspection <br />Date: ���/2'�2� <br />Facility <br />Address: <br />� � � , �j/``Q��4� �'iS�� <br />2 <br />HSC 25505, <br />25508 a 1 <br />CERS <br />ID: <br />�' G/i �� � <br />Inspection <br />Contact: <br />/ Title: <br />� t�/G /V M(�GSS �GL�!%L'�iZ� <br />�i1L�� <br />Phone: <br />�D .�.(�p7�- z0lf /� <br />Inspection <br />Type: <br />1 Program: 1 Q <br />�. 0(�-G l n � / %Z! <br />❑ <br />❑ <br />4 <br />HSC 25508(a)(i) <br />Failed to complete and/or submit the Business Activities or Owner/Operator Identification page (V345) <br />p � � h2 ^pG�i l o �� tc� G'1-/'�� <br />❑ <br />❑ <br />5 <br />HSC 25506(a) <br />Failed to complete and/or submit hazardous materials inventory for all reportable materials on site (V343) <br />COMPLY BY THE ABOVE NOTED DATES WILL BE BILLED AT THE CURRENT HOURLY RATE. <br />Con nt Given For: Consent �-%` � ' <br />Given By: A ��i l L �l(�jl <br />❑ <br />6 <br />HSC 25505(a)(3) <br />nspection <br />I�hotos ❑Sampling <br />❑ <br />❑ <br />7 <br />CCR =California Code of Regulations HSC =Health and Safety Code CFR =Code of Federal <br />Regulations <br />SJO =San Joaquin <br />County Ordinance <br />❑ <br />V =Violation <br />R = Re eat <br />COS =Corrected on <br />site during ins ection <br />EHD 19-01 REV 07/28/16 rage i ���� ������� � ���� � ��� �� <br />Violations <br />V <br />R <br />COS <br />1 <br />SJO 4432 <br />Failed to pay annual operating fees (V851) <br />❑ <br />❑ <br />❑ <br />2 <br />HSC 25505, <br />25508 a 1 <br />Failed to complete and electronically submit a hazardous materials busiriess plan (V335) <br />�' G/i �� � <br />❑ <br />❑ <br />3 <br />HSC 25507 <br />Failed to establish and implement a hazardous materials business plan (V334) <br />❑ <br />❑ <br />4 <br />HSC 25508(a)(i) <br />Failed to complete and/or submit the Business Activities or Owner/Operator Identification page (V345) <br />p � � h2 ^pG�i l o �� tc� G'1-/'�� <br />❑ <br />❑ <br />5 <br />HSC 25506(a) <br />Failed to complete and/or submit hazardous materials inventory for all reportable materials on site (V343) <br />COMPLY BY THE ABOVE NOTED DATES WILL BE BILLED AT THE CURRENT HOURLY RATE. <br />❑ <br />❑ <br />6 <br />HSC 25505(a)(3) <br />Failed to complete and/or submit a site map with all required content (V347) <br />❑ <br />❑ <br />7 <br />HSC 25505(a)(3) <br />Failed to establish and/or submit emergency response procedures for a release or threatened release Ivsae� <br />47� <br />❑ <br />❑ <br />8 <br />HSC 25505(a)(4) <br />Failed to submit a training program or program is not reasonable or adequate for facility (V350) <br />❑ <br />❑ <br />9 <br />HSC 25508.2 <br />Failed to annually review and certify that the business plan is complete, accurate, and up to date (V342) <br />❑ <br />❑ <br />10 <br />HSC 25508.1 (a -f) <br />Failed to submit revisions to HMBP within 30 days of substantial change in operations (V346) <br />❑ <br />❑ <br />❑ <br />11 <br />HSC 25505(a)(4) <br />Failed to provide or document initial and/or refresher training to appropriate personnel (V349) <br />❑ <br />❑ <br />❑ <br />12 <br />HSC 25505(c) <br />Failed to have the business plan readily available to facility or EHD personnel (V850) <br />❑ <br />❑ <br />13 <br />HSC 25505.1 <br />Failed to notify property owner that facility is subject to and in compliance with the HMBP program (V341) <br />❑ <br />❑ <br />❑ <br />14 <br />HSC 25510 <br />Failed to report actual or threatened release to the EHD and/or CaIOES Warning Center (V338) <br />❑ <br />❑ <br />❑ <br />15 <br />HSC 25507.1 <br />Failed to submit emergency response plan when not meeting Ag handler exemption requirements (351) <br />❑ <br />❑ <br />❑ <br />16 <br />HSC 25507.1 <br />Failed to submit training program when not meeting Ag handler exemption requirements (V352) <br />❑ <br />❑ <br />❑ <br />17 <br />HSC 25507.2 <br />Failed to establish and implement a HMBP when not meeting remote unstaffed facility exemptions (V353) <br />❑ <br />❑ <br />❑ <br />18 <br />HSC 25511 <br />Failed to submit a written response within 30 days of receiving an inspection report (V808) <br />❑ <br />❑ <br />❑ <br />1010 <br />See below <br />Unlisted Administration/Documentation violation (V355) <br />❑ <br />❑ <br />❑ <br />1040 <br />See below <br />Unlisted Release/Leaks/Spills violation (V356) <br />❑ <br />❑ <br />❑ <br />EHD 19-01 REV 07/28/16 rage i ���� ������� � ���� � ��� �� <br />SUMMARY <br />OF VIOLATIONS <br />CLASS I, <br />CLASS II, or MINOR -Notice to Com I <br />�.� 6 A-� � <br />yl'�0 n t <br />t� �/vti c�CS � � x <br />� �� �Q-LL <br />�' G/i �� � <br />1��. ,�,,Ir� <br />ice s <br />� a, to 6�'���� B� � • >as <br />flan, NM �l' <br />.� � �,n-���fo��;G� <br />�2���a <br />,�� �'� <br />� t��� <c�o5 <br />6OS(1�4L z°� � fJ0 <br />��ar y <br />p � � h2 ^pG�i l o �� tc� G'1-/'�� <br />a� �lo.^s <br />of di�S�L. <br />ALL EHD STAFF TIME ASSOCIATED WITH FAILING TO <br />COMPLY BY THE ABOVE NOTED DATES WILL BE BILLED AT THE CURRENT HOURLY RATE. <br />THIS FACILITY IS SUBJECT <br />TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br />Received by (signature): <br />� <br />`� <br />Title: <br />1 ��'ativlex� D ����tod' <br />Date: <br />�i"3 -- 2oZ,1 <br />0 5i n <br />o �,�y�G� <br />Received (printed name): <br />��til i n <br />r,�yyi <br />Inspector: <br />Nig �' L.m�klre6 <br />Inspector phone: <br />��- 062 � <br />EHD 19-01 REV 07/28/16 rage i ���� ������� � ���� � ��� �� <br />