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, <br />PUBLIC HEALTH SERVICES <br />SAN JOAQUIN COUNTY _ <br />i �^ <br />ENVIRONMENTAL HEALTH DMSION "- <br />Karen Furst, M.D., M.P.H., Health Officer �T <br />GjF�RH <br />304 East 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 <br />Facility Contact <br />Phone <br />Consent Given By <br />i <br />Inspection Date(s) Inspection Type (circle) <br />0. • <br />outine Complaint Follow -Up <br />Organization <br />a ,'t <br />Sb A4 <br />1\ <br />t a t t,Ee <br />one or more <br />ons o <br />This report may identify conditions observed this day that <br />are of Regulations,tito be Titleations 22 (22 of <br />CCR) relating tot'rthe management nt0 <br />Health and Safety Code (HSC) or the California C <br />attachedn more detail on the <br />hazardous waste. The violations may be describ edction PHS EHD may inform youof additional violations. <br />completing t; <br />evaluation of the information obtained during the i p <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 specified (A certification form is provided). <br />Failure to correct these violations within the scheduled period <br />p^ridedresult <br />in San JoaquinCounty ublicHea' <br />Services -Environmental Health Division (PHS-EHD) ct g you o ing/addto olatioof this on <br />^;w1rVr, <br />rriminnl action as a result of the violations noted. <br />Report does not preclude PHS-EHD from taking any adr'- <br />Environmental Heal pecialis <br />1219198 <br />A Division oESan Joaquin County Health Care Services <br />Pagel of <br />