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PUBLK]l <br /> HEALTH SERVICES <br /> SAN J.OAQUIN COUNTY . <br /> ENVIRONMENTAL HEALTH DMSION <br /> Karen Furst, M.D., M.P.H., Health Officer • �` �'• <br /> 304 Eas Weber Avenue,Third Floor • Stockton, CA 95202 <br /> 209/468-3420 <br /> UNIFIED PROGRAM HAZARDOUS WASTE INSPECTION REPORT <br /> Facility Name <br /> Address <br /> State CA Zip Code <br /> City �� ✓' `� �� <br /> EPA I.D.Number (A o <br /> Facility Contact r\.�t a <br /> c �a Phone i " � <br /> Consent Given By �� <br /> Inspection Date(s) <br /> C <br /> L, Inspection Type (circle): Routin Complaint Follow-Up <br /> REPRESENTATIVES PRESENT <br /> Title <br /> Organization <br /> _ <br /> Name ! 1�.� �, � ���r��►LI°w`1 ..i"v'a il <br /> J <br /> This report may identify conditions observed this day that are alleged to b e ti n 22 f one or relating more sections <br /> of the Californiamen <br /> Health and Safety Code (HSC) or the California Code of Regulations, Titl <br /> t of <br /> hazardous waste. The violations may be described PHS EHD may inform youore detail on the additional v olat onsr completing the <br /> evaluation of the information obtained during the inspection, <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 sp cified (A certification form is provided). <br /> Failure to correct these vio ations within the scheduled period pidedmay result <br /> innJoquinCounty Public <br /> ub isHelth <br /> Services-Environmental He Ith Division (PHS-EHD) citing you oning/addto violations. of this <br /> Report does not preclude P S-EHD from taking any administrative, 'vil or criminal action as a result of the violations noted. <br /> ` ceived y Date <br /> Environmental Health Speci <br /> Is <br /> Page 1 of <br /> 12/9198 <br /> A Division of San Joaquin Counry Health Care Services <br />