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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, California 95206-6232 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.si4ay.orplehd <br /> CONTINUATION FORM Page: 5 of 5 <br /> OFFICIAL INSPECTION RERORT Date: 10/10/13 <br /> Facility Address: 508 W. Dr. MLK, Jr. Blvd., Stockton Program: HW <br /> SUMMARY OF VIOLATIONS <br /> CLASS I,CLASS II, --MINOR-Notice to Comply) <br /> 9999. The facility has not made any submittals on the California Environmental Reporting System <br /> (CERS).. Regulated businesses shall report program data electronically in the state information <br /> management system. Immediately submit all hazardous waste information, and any other required <br /> program information, into the CERS system. <br /> Complete and submit a copy of the Return to Compliance Certification to the EHD by November 10, <br /> 2013 along with a statement documenting the corrective actions that have been or will be taken for each <br /> violation and any supporting paperwork. <br /> Provided: <br /> Return to Compliance Certification form <br /> Modified Contingency Plan template <br /> CERS flier <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,#t ANY T AT EHD' URRENT HOURLY RATE. <br /> EHD Inspector: Recei By: Title: <br /> Stacy Rivera (209) 468-3440 <br /> EHD 23-02-003 Rev 04119/12 CONTINUATION FORM <br />