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HEALTH SE :PUBLIC <br />UIN COUNTY Y.ojz' <br />sAN jOAC� ENVIRONMENTAL. HEALTH DIVISIONKaren Furst, M.D., M.P.H., Health Officer <br />304 East Weber Avenue, Third Floor • Stockton, CA 95202 <br />2091468-3420 <br />UNIFIED PROGRAM HAZARDOUS WASTE INSPECTION REPORT <br />��- <br />Facility Name <br />Address <br />2 State CA Zip Code a <br />City <br />EPA I.D.Number <br />Facility Contact t <br />Consent Given By <br />Inspection Date(s) �' � 6t' Inspection Type (circle)' ©utin Complaint Follow -Up <br />REPRESENTATIVES PRESENT <br />Title Or ni <br />zation f <br />arae � � 5 �cric A <br />G� v �_j <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 deribed enCodomore detain onTitle <br />the attached natersiheets.t© After completing ng the <br />the management of <br />hazardous waste. The violations may b <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 (PNS-EHD) citing you for continuing/additional violations. Issuance of this Inspection <br />Report does not preclude PHS-EHD from taking any administrative, civ criminal actio s a result of the violations noted. <br />./ �.�--- <br />Date <br />Environmental Health Specialist Rec <br />Page 1 of <br />1219198 <br />A Division of San Joaquin Counry Health Care Services <br />