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Cal-EPA DEPARTMENT OF TOXIC SUQWANCES CONTROL Adook Arnold Schwarzenegger, Governor <br /> SAKI 16AQUIN COUNTY UNIFIED PROGRAM AGENCY •r <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 E MAIN ST. <br /> STOCKTON, CA 95202-3029 <br /> CHECKLIST AND INITIAL VERIFICATION INSPECTION REPORT FOR <br /> Permit by Rule, Conditionally Authorized, and Conditionally Exempt Notifiers <br /> SIGNATURE SHEET <br /> Onsite Recycling: Only answer if this facility recycles more than 100 kilograms/month of hazardous waste onsite. <br /> NO <br /> 27. The appropriate local agency has been notified. HSC 25143.10 <br /> 28. Activities claimed under the onsite recycling exemption are appropriate. HSC 25143.2 et sec. <br /> Releases: <br /> YES <br /> 29. Within the last three years, were there any unauthorized or accidental releases to the <br /> environment of hazardous waste or hazardous waste constituents from onsite treatment units? <br /> 30. Within the last three years, were there any unauthorized or accidental releases to the <br /> environment of hazardous waste or hazardous waste constituents from any location at this <br /> facility? <br /> For purposes of a Tiered Permitting inspection, a release to the environment is unauthorized or <br /> accidental and does not include spills contained within containment systems. <br /> Source Reduction: <br /> 31. Generator was subject to S1314 OR SB1796 and failed to prepare and retain current source <br /> reduction documents, as applicable, and make them available to the inspector within (5) days. A <br /> checklist or plan is required only if annual hazardous waste volume is overr S,000 kilograms (approximately 11,000 <br /> pounds or 1,350 gallons). <br /> 32. Source Reduction Evaluation Review and Plan failed to contain, at a minimum, the following <br /> five required elements: certification, amounts of wastes generated, process description, block <br /> diagrams, and implementation schedule of selected source reduction measures. <br /> This report may identify conditions observed this date that are alleged to be violations of one or more sections of the <br /> California Health and Safety Code(HSC) or the California Code of Regulations, Title 22 (22 CCR) relating to the management <br /> of hazardous waste. The violations may be described in more detail on the attached note sheets. If any violations are noted, the <br /> facility is required to submit a signed Certification of Return to Compliance within 30 days, unless otherwise specified. (A <br /> certification form is provided.) If any corrections are needed to the initial notification, the facility will submit a revised <br /> notification within 30 days to the Department of Toxic Substances Control with a copy to the local enforcement agency. DTSC <br /> or the local enforcement agency may reinspect, at any time, to verify compliance with this Notice to Comply. <br /> Inspector(s): <br /> Lead Inspector Other Inspector: <br /> Signature: Signature: <br /> Print Name: Pt n4Name: fZ*Yk1-P- J (rpt <br /> Title: �r. tL 6:-14 S Title: (,e," <br /> Agency: S SG Grwi o^.4—4?rt( H Agency: ST G C <br /> Phone Number: �_ �(, �� Phone Number: ow <br /> Facility Representative: <br /> Your signaturecnowled rec ',pt of this report and does not imply agreement with the findings. <br /> Signature: Print Name- W Iij <br /> Title: - Date: w(glia <br /> Onsite Checklist (C) Page of 9 Rev 06/08/07 <br />