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ENVIRONMENTAL HEALTH DEPARTMENT <br /> . <br /> a u i ry SAN JOAQUIN COUNTY <br /> Unit Supervisors <br /> Carl Borgman,R.E-H.S. <br /> Third Floor <br /> 2 '-' `'a•Z Donna K.Reran,R.E.Hs• 304 East Weber Avenue, Mike Huggins,R.E.H.S.,R.D.I. <br /> DirectorStockton, California 95202-2708 Douglas W.Nilson,R.E.H.S. <br /> Al Olsen,R.E.H.S. Margaret Lagorio,R.E.H.S. <br /> . �: :• <br /> P'• program Manager Telephone: (209) 468-3420 Robert McClellon,R.E.H.S. <br /> S <br /> Z. <br /> F ORa Laurie A.Cotulla,R.E.H.S. Fax: (209) 464-0138 Mark Barcellos,R.E.H.S. <br /> Program Manager <br /> UNIFIED PROGRAM HAZARDOUS WASTE INSPECTION REPORT <br /> Facility Name <br /> Address <br /> State CA.Zip Code <br /> City <br /> Industry Type <br /> EPA I.D.Number <br /> �, ���c�-Title• <br /> Phone <br /> Facility Contact F� <br /> Consent Given By � <br /> � o-�- Inspection Type (circle): . out' Complaint Follow-Up <br /> Inspection Date(s) <br /> REPRESENTATIVES PRESENT <br /> Title Organization <br /> Name , <br /> Title 22 (22 CCR) relating to the management <br /> a identify conditions observed this day that are alleged tobeviolations of one or more sections of the Cali ori <br /> This report may fy � completing <br /> Health and'Safety Code (HSC) or the California Code of Regulation <br /> h <br /> azardous waste. The violations may be described inm re detail 'on the attached note s <br /> you may informed of additional violations.After comp <br /> evaluation of the information obtained during the inspection,y Bance within <br /> If y <br /> an violations are noted,the facility is required to submit ceed Certification of Return to Comp <br /> days,unless otherwise specified (A certification form isprovided). <br /> uin County Environme <br /> may result in San <br /> Failure to correct these violations within the <br /> tinuin eadditd�onallva lations els uance of th s nspect on Report does not p <br /> recl <br /> Health Department(EHD)citing you for con 9ls noted. <br /> EHD from taking any administrative,civil or criminal action as a esult <br /> Received by kW <br /> Environmental Health Specialist <br /> Page 1 of <br /> 315102 <br />