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PUBLIC HEALTH SERVICES <br /> SAN JOAQUIN COUNTY '0.i'4 <br /> r.� <br /> ENVIRONMENTAL HEALTH DIVISION <br /> Ernest M. Fujimoto, M.D., M.P.H., Acting Health Officer <br /> 304 E.Weber Ave., 3rd Floor • P. O. Box 388 • Stockton, CA 95201-0388 c9<ikoR' P <br /> 209/468-3420 <br /> HAZARDOUS WASTE INSPECTION REPORT <br /> Facility Name <br /> Address��� f. <br /> City 2'22 G/l State CA Zip Code <br /> EPA I.D.Number <br /> Facility Contact Phone <br /> Consent Given By Fd C� GAJ Yom' SaotZ'�SE <br /> Inspection Date(s) Inspection Type (circle): Routine omplain Follow-Up <br /> REPRESENTATIVES PRESENT <br /> Name Title Organization <br /> This report may identify conditions observed this day that are alleged to be violations of one or more sections of the <br /> California Health and Safety Code (HSC) or the California Code of Regulations, Title 22 (22 CCR) relating to the <br /> management of hazardous waste. The violations may be described in more detail on,the attached note sheets. After <br /> completing the evaluation of the information obtained during the inspection, PHS-EHD may inform you of additional <br /> violations. <br /> If any violations are noted, the facility is required to submit a signed Certlficatlon 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 <br /> Inspection Report does not preclude PHS-EHD from taking any administrative, civil or criminal action as a result of the <br /> violations noted. <br /> / / .F. <br /> Adt <br /> Registered Environmental Health Specialist Received by Date <br /> 1219/94 Page 1 of— <br /> Division or San .loaquin Count} Health Care Services <br />