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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: v~.s6 ov.org/ehd <br />Hazardous Materials Program Inspection Report <br />Facility Name: <br />Facility Address: <br />1 <br />Date: <br />SJC PUBLIC WORKS/UTILITY-SJ WATER# <br />17900 N BRUELLA RD VICTOR <br />Aril 13 2016 <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, by 5/13/2016 <br />Please be aware as of January 1, 2013, all businesses are required to submit all hazardous materials information <br />online to the California Environmental Reporting System (CERS) at http://cers.calepa.ca.gov. Be sure to include <br />your hazardous material activity in the Businesses Activities section in CERS in addition to any other relevant <br />activities and required fields. <br />AFTER THE COMPLIANCE DATE, EHD WILL BILL FOR ALL TIME AND ACTIVITIES ASSOCIATED WITH BRINGING THIS <br />FACILITY BACK INTO COMPLIANCE. <br />THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE <br />Received by: Date: <br />Inspector: <br />Inspector Phone: <br />n Z -r-- <br />Printed Name and Title: <br />JAMIE DE LA ROSA, HM Specialist II <br />(209) 953-6211 <br />Page 2 of 2 <br />