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SAN" J D�l+ �� I 1411" Environmental Health Department COUNTY�l Small Quantity Hazardous Waste Generator Inspection Report Facility Name: Facility Address: Date: Super Store Industries-Grocery Division 1 16888 McKinley Ave Lathrop Aril 29 2019 SUMMARY OF VIOLATIONS (CLASS I,CLASS II,or MINOR-Notice to Comply) Item# Remarks 110 CCR 66262.40(a) Failed to keep signed copy of manifests from the designated facility for three years. Manifest number 012800822FLE(3/25/2019)was not found on site. Hazardous waste generators shall retain copies of all manifests for three years or until a copy signed off by the destination facility is received. The signed off copy shall be retained and made readily available for review for three years. If the generator did not receive a copy of the manifest with the handwritten signature of the owner or operator of the facility to which the generator's waste was submitted within 60 days of the date the waste was accepted by the initial transporter, the generator shall submit a legible copy of the missing manifest,with some indication that the generator has not received confirmation of delivery. This information shall be submitted to: DTSC Report Repository Generator Information Services Section P.O. Box 806 Sacramento, CA 95812-0806 Immediately locate a copy of the missing manifest or prepare and submit the required information to DTSC. Submit to the EHD a copy of the signed off copy of the manifest or a copy of the information submitted to DTSC. This is a repeat violation, Class II. 111 CCR 66262.42(a)(c)(d)Failed to comply with uniform hazardous waste manifest exception requirements. Manifest number 012800822FLE(3/25/2019)was not found on site. Hazardous waste generators shall retain copies of all manifests for three years or until a copy signed off by the destination facility is received. The signed off copy shall be retained and made readily available for review for three years. If the generator did not receive a copy of the manifest with the handwritten signature of the owner or operator of the facility to which the generator's waste was submitted within 60 days of the date the waste was accepted by the initial transporter, the generator shall submit a legible copy of the missing manifest,with some indication that the generator has not received confirmation of delivery. This information shall be submitted to: DTSC Report Repository Generator Information Services Section P.O. Box 806 Sacramento, CA 95812-0806 Immediately locate a copy of the missing manifest or prepare and submit the required information to DTSC. Submit to the EHD a copy of the signed off copy of the manifest or a copy of the information submitted to DTSC. This is a repeat violation, Class II. FA0003833 PRO514244 SCO01 04/29/2019 EHD 22-01 Rev.09/27/2018 Page 8 of 14 Small Quantity Hazardous Waste Generator OIR 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com