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State of California <br />Department of Health Services <br />Hazardous Waste Management Brancb <br />Date <br />Firm Name <br />Address <br />Person Interviewed <br />HAZARDOUS WASTE <br />MANAGEMENT REPORT <br />EPA I.D. No. <br />❑ Facility <br />❑ Other — <br />4250 Power Inn Rd., Sacramento 95826 <br />(916) 739-3145 <br />5545 E. Shields Ave, Fresno 93727 <br />(209) 291-6676 <br />2151 Berkeley Way, Berkeley 94704 <br />(415) 540-2043 <br />107 S. Broadway, Los Angeles 90012 <br />(213) 620-2380 <br />❑ Hauler ❑ Producer <br />The following conditions or practices observed this date are alleged to be violations of one or more sections of the <br />California Health and Safety Code, Division 20, or the California Administrative Code, Title 22, relating to the <br />storage, handling, transportation, and disposal of hazardous and extremely hazardous waste or asbestos containing <br />products. The inspection and the collection of samples or other evidence, including the taking of photographs, was <br />conducted under authority of Section 25185, California Health and Safety Code and Section 66328, California <br />Administrative Code. <br />Your signature acknowledges receipt of a copy of this report and collection of any samples described above. <br />Authorized Representative of Firm <br />Name <br />Title <br />Authorized Agent <br />EH 202 (12182) Page _ of <br />8019.002 <br />