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Environmental Health Department <br />c=u IN I y <br />EHD 19-01 Rev. 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 />Hazardous Materials Program Inspection Report <br />Facility Name:j� <br />���t <br />Facility Ad�ss: <br />� L? E Y9, 2 /1? <br />Date: <br />SUMMARY OF VIOLATIONS <br />(CLASS I, CLASS II, or MINOR - Notice to Comply) <br />Item # <br />Remarks <br />Overall Inspection Comments: <br />An inspection <br />checklist was provided to the facility operator at the time of inspection. The inspector will provide <br />a complete report <br />to the facility operator within the next few weeks. <br />Complete and <br />submit a copy of the Return to Compliance Certification form to the EHD with a statement <br />documenting the <br />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 <br />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:17%2-`f /202 <br />Inspector: <br />Inspector Phone: <br />%h� <br />eL <br />Printed <br />ntePrintedNName and Title: <br />CAA <br />� <br />/% <br />! V (�i <br />EHD 19-01 Rev. 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 />