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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.swgov.org/ehd <br />CONTINUATION FORM <br />Page: 6 of 6 <br />OFFICIAL INSPECTION REPORT <br />Date: 08/20/13 <br />Facility Address: Flag City Chevron 6421 Capitol Ave. Lodi, CA 95242 <br />Program: HW <br />SUMMARY OF VIOLATIONS <br />CLASS I, CLASS II, or MINOR -Notice to Comply) <br />a record of each shipment of universal waste sent from the universal waste handler's facility to another <br />facility. The record may take the form of a log, invoice, manifest, bill of lading or other shipping <br />document. The record for each shipment of universal waste sent shall include the following information: <br />(1) The mane and address of the universal waste handler or destination facility to which the universal <br />waste was sent; (2) The quantity [count or weight, consistent with, for example, section 66273.32, <br />subsection (d)] of each type of universal waste sent (e.g., batteries, thermostats, lamps, electronic <br />devises, CRTS, CRT glass); (3) The date of departure of the shipment of universal waste. (d) Record <br />retention. (1) A universal waste handler shall retain each record described in subsection (a) of this <br />section for at least three years from the date of receipt of the corresponding shipment of universal waste. <br />(2) A universal waste handler shall retain each record described in subsection (c) of this section for at <br />least three years from the date of departure of the corresponding shipment of universal waste. <br />Immediately locate a copy of all disposal records for universal waste for the last three years, maintain <br />them on site, and submit copies to the EHD by September 20, 2013. <br />Complete and submit a copy of the Return to Compliance Certification form with a statement of how <br />each violation was corrected, including supporting documentation, by September 20, 2013. <br />Ensure that all required information has been entered in the online California Electronic Reporting <br />System. <br />ALL EHD STAFF TIME ASSOCIATED WITH FAILING TO COMPLY BY THE ABOVE NOTED DATES WILL BE BILLED AT THE CURRENT HOURLY RATE. <br />THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br />EHD Inspector: <br />,,%- <br />Aris Cacapit (209) 468-3453 C - <br />Recived By: <br />-, - —,, L_, <br />Title: <br />EHD 23-02-003 Rev 04/19/12 CONTINUATION FORM <br />