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ENVIRONMENTAL HEALTH EPARTMENT <br /> SAN JOAQUIN COUNTY <br /> Unit Supervisors <br /> Donna K.Hera n,R.E.H.S. Third Floor Carl Borgman,R.E.ELS. <br /> < <br /> 304 East`Veber Avenue, Mike Huggins,R.E.H.S.,R.D.I. <br /> W Direct)r <br /> Al Olsen, E.H.S. Stockton, California 95202-2708 Douglas W.Nilson,R.E.H.S. <br /> Telephone: (209) 468-3420 Margaret Lagorio,R.E.H.S. <br /> • c Program N annger Robert McClellon,R.E.H.S. <br /> Q�iFOR� Laurie A.Cotu la,R.E.H.S. Fax: 209 464-0138 <br /> Program Manager ) Mark Barcellos,R.E.H.S. <br /> UNIFIED PROGRAM HAZARDOUS WASTE INSPECTION REPORT <br /> Facility Name <br /> Address 15 �L <br /> State CA Zip Code �ZG 01 <br /> City <br /> EPA I.D.Num CO Industry Type <br /> �d itle � Phone <br /> Facility Contact 1 <br /> Consent Given By <br /> Title <br /> Inspection Date(s) Inspection Type (circle): Routin Complaint Follow-Up <br /> REPRESENTATIVES PRESENT <br /> Title Organization <br /> m <br /> Nae r— C <br /> ,sem Q <br /> ,ed <br /> ons of the <br /> rnia <br /> This report may identify con itions observed this day that are allegdto be lations 22 (22of <br /> relating toone or more t'the manageme�t of <br /> Health and Safety Code (HSC) or the California Code of Regulations, Title <br /> hazardous waste. The violations may be described in more deit onf the <br /> attach <br /> dit onal ed noshevioets. <br /> ,After completing the <br /> evaluation of the information obtained during the inspection,you ma <br /> y <br /> be If any violations are noted, the facility is required to submit asiggned Certification of Return to Compliance within 60 <br /> days,unless otherwise specified (A certification form is proved ) <br /> . may result in San aq <br /> in County Environmental <br /> Failure to correct these vi lations within the scheduled period provided <br /> of this nspec onuReport does not preclude <br /> Health Department(EHD) iting you for continuing additional violations. <br /> EHD from taking any administrative, civil or criminal action as a result of he violations noted. <br /> Received by Date <br /> �ironmHealth Specialist r <br /> Page 1 of J <br /> 3/5/02 <br />