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F <br /> ENVIRONMENTAL HEALTH -REPARTMENT <br /> aA°'!.N SAN JOAQUIl`�I COUNTY Unit Supervisors <br /> Donna K.Heran,R.E.H.S. Carl Bergman, R.E.H.S. <br /> a x Director 304 East Weber Avenue, Third Floor Mike Huggins,R.E.H.S.,R.D.I. <br /> ` Al Olsen,R.E.H.S. Stockton, California ��2©2-2��c� Douglas W.Wilson,R.E.H.S. <br /> • �P Program Manager j�je�7hQne: (209) 4�8-3420 Margaret Lagorio,R.E.H.S. <br /> Robert McClellon,R.E.H.S.Laurie A.Cotulla,R.E.H.S. Fax: (209) 464-0138 Mar:Barcellos,R.E.FI.S.Pr . t lt <br /> UNIFIED PROGRAM HAZARDOUS WASTE INSPECTION REPORT <br /> Facility Name <br /> Address Z <br /> City��, <br /> - } state �Zip Code 20 <br /> EPA I.D.Number C —Industry Type__ (elct`�7 <br /> Facility Contact ?Idjt <br /> Title' Phone �� � r 3� <br /> Consent Given By { Title <br /> Inspection Date(s) 3 Inspection Type (circle): outin Complaint Follow-Up <br /> REPRESENTATIVES PRESENT <br /> t&Name Title Organi tip <br /> �" f s <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,you may be informed 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 Environmental <br /> Health Department(EHD) citing you for continuing/additional violations. Issuance of this Inspection Report does not preclude <br /> EHD from taking any administrative, civil or criminal action as a result of the vi ations noted. <br /> �a 3 <br /> Jnme Lj��& <br /> lth Speci Ist �Rece Date <br /> Page i of <br /> 315102 <br />