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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 />HAZARDOUS <br />MATERIALS PROGRAM INSPECTION <br />REPORT <br />R <br />COS <br />Facility ,p/ <br />Name: �/ i��L <br />// Facility p <br />��GL � � Phone:2�% /�_ <br />/ Q <br />(�"O��u� <br />� <br />Inspection <br />Date: <br />�/� ZOZ% <br />L!'� <br />HSC 25505, <br />25508 a 1 <br />Failed to complete and electronically submit a hazardous materials business plan (V335) <br />`�;e � dal, <br />❑ <br />❑ <br />Facility y� O � a / <br />Address: c c <br />VQ n n�n ��C� /� <br />(� � V l j'Z <br />Failed to establish and implement a hazardous materials business plan (V334) <br />CERS <br />ID: <br />❑ <br />4 <br />HSC 25508(a)(1) <br />Failed to complete and/or submit the Business Activities or Owner/Operator Identification page (V345) <br />ALL EHD STAFF TIME ASSOCIATED WITH FAILING TO COMPLY BY THE ABOVE NOTED DATES WILL BE BILLED <br />❑ <br />❑ <br />Inspection � �,y - `- ^ A <br />Contact: ((�� I G I rJ ! V ` !.� Jill' 1 <br />Title: © a� �� <br />rn <br />�tSr✓DL� t°n � <br />Failed to complete and/or submit hazardous materials inventory for all reportable materials on site (V343) <br />Phone: <br />Zr% <br />O , <br />'1 <br />— G D7 � 2 Z 1� <br />Inspection n <br />Type: ®�� �1 %L�i <br />6 <br />Program: Z r <br />�� <br />Failed to complete and/or submit a site map with all required content (V347) <br />q/ <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 (vaae> <br />�/' <br />❑ <br />❑ <br />8 <br />9 <br />HSC 25505(a)(4) <br />HSC 25508.2 <br />Failed to submit a training program or program is not reasonable or adequate for facility (V350) <br />Failed to annually review and certify that the business plan is complete, accurate, and up to date (V342) <br />r�/ <br />� <br />Co99��ent Given For:// Consent <br />inspection Given By: A �i/ �/ d %� u SllJ <br />❑ <br />❑ <br />10 <br />HSC 25508.1 (a -f) <br />r�Photos ❑Sampling <br />❑ <br />❑ <br />❑ <br />11 <br />CCR =California Code of Regulations HSC =Health and Safety Code CFR =Code of Federal Regulations <br />SJO =San <br />Joaquin <br />County Ordinance <br />❑ <br />V =Violation R =Repeat <br />COS =Corrected on <br />site during ins ection <br />EHD 19-01 REV 07/28/16 rage � 1 uvl IIYJrLV I IVIY 111 ...111 <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 business plan (V335) <br />`�;e � dal, <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)(1) <br />Failed to complete and/or submit the Business Activities or Owner/Operator Identification page (V345) <br />ALL EHD STAFF TIME ASSOCIATED WITH FAILING TO COMPLY BY THE ABOVE NOTED DATES WILL BE BILLED <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 />�✓ <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 />q/ <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 (vaae> <br />�/' <br />❑ <br />❑ <br />8 <br />9 <br />HSC 25505(a)(4) <br />HSC 25508.2 <br />Failed to submit a training program or program is not reasonable or adequate for facility (V350) <br />Failed to annually review and certify that the business plan is complete, accurate, and up to date (V342) <br />r�/ <br />� <br />❑ <br />❑ <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 />❑ <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 � 1 uvl IIYJrLV I IVIY 111 ...111 <br />SUMMARY OF VIOLATIONS <br />CLASS I, CLASS II, or MINOR _Notice to Com I <br />,�° U ��a� b�� o� <br />� oun s of � �� ��, � o itc � <br />`�;e � dal, <br />t=F/�I.� � � �i�o6nr`� <br />`�o men��� <br />6-�i/� s � <br />t rte- CE6'S ��X i rvt a1�t>° C <br />ov a. �l�n <br />ALL EHD STAFF TIME ASSOCIATED WITH FAILING TO COMPLY BY THE ABOVE NOTED DATES WILL BE BILLED <br />AT THE CURRENT HOURLY RATE. <br />THIS FACILITY IS <br />SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br />Received by (signature): <br />�u� t� o �/i�� � � <br />Title: <br />13>!ot ��`1,e�. � Op�6�-��0' <br />Date: <br />S �3 2, o � l <br />No Si n <br />�' <br />Received by (printed name): <br />Inspector: <br />Inspector phone: <br />A�tl"!ia Muss <br />N'��1C L���t�'c�' <br />20-��B-�bL3 <br />EHD 19-01 REV 07/28/16 rage � 1 uvl IIYJrLV I IVIY 111 ...111 <br />