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Environmental Health Department <br />U >%� I y <br />Hazardous Materials Program Inspection Report <br />EHD 19-01 Rev, <br />Facility Name: <br />Facility Address: <br />165 2, 6, W <br />Date: <br />lU1z�/z<�z <br />SUMMARY OF VIOLATIONS <br />(CLASS I, CLASS II, or MINOR - Notice to Comply) <br />Item # Remarks <br />Overall Inspection Comments: <br />An inspection checklist was provided to the facility operator at the time of inspection. The inspector will provide <br />a complete report to the facility operator within the next few weeks. <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, within 30 days of receiving the complete inspection report. <br />AFTER THE COMPLIANCE DATE, EHD WILL BILL FOR ALL TIME AND ACTIVITIES ASSOCIATED WITH BRINGING <br />THIS FACILITY BACK INTO COMPLIANCE. <br />THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br />Received by: <br />Date: J 'Crh' D7it <br />/0/ / <br />Inspector: <br />6 /� <br />P <br />•✓ e �/ C ✓` dtee Printed Name and Title: <br />IV) G,e z,,Pe h - fe <br />Inspector Phone: <br />vo" Aja <br />12/06/2021 Page 2 of 2 Hazardous Materials Program OIR <br />1868 E. Hazelton Avenue � Stockton, California 95205 � T 209 468-3420 � F 209 464-0138 � www.sjgov.org/EHD <br />