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PUBLIC HEALTH SERVICES �o..PQU�� c <br /> SAN JOAQUIN COUNTY x <br /> ENVIRONMENTAL HEALTH DIVISION <br /> Karen Furst, M.D., M.P.H., Health Officer _ <br /> 304 East Weber Avenue,Third Floor • Stockton, CA 95202 <br /> 209/468-3420 <br /> UNIFIED PROGRAM HAZARDOUS WASTE INSPECTION REPORT <br /> Facility Name i r <br /> Address ( C1 <br /> City State CA Zip Code <br /> EPA I.D.Number G 3 <br /> Facility Contact Phone 5 <br /> Consent Given By t 4 <br /> Inspection Date(s) (, ! Inspection Type (circle): Routine)Complaint Follow-Up <br /> REPRESENTATIVES PRESENT <br /> Name Title Organization ` <br /> 1 <br /> This report may identify conditions observed this day that are alleged to be violations of one or more sections of the California <br /> Health and Safety Code (HSC) or the California Code of Regulations, Title 22 (22 CCR) relating to the management of <br /> hazardous waste. The violations may be described in more detail on the attached note sheets. After completing the <br /> evaluation of the information obtained during the inspection, PHS-EHD may inform you of additional violations. <br /> If any violations are noted, the facility is required to submit a signed Certification of Return to Compliance within 60 <br /> days, unless otherwise specified (A certification form is provided). <br /> Failure to correct these violations within the scheduled period provided may result in San Joaquin County Public Health <br /> Services-Environmental Health Division (PHS-EHD) citing you for continuing/additional violations. Issuance of this Inspection <br /> Report does not preclude PHS-EHD from taking any administrative,civil or criminal action as a result of the violations noted. <br /> 1.4A 6 Cid <br /> E vironmental H alth Spe a t dei d by Date <br /> 1219198 Page 1 of <br /> A Division of San Joaquin Counry Health Care Services <br />