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SHAWNEnvironmental Health Department <br /> COUNTY— <br /> Small Quantity Hazardous Waste Generator Inspection Report <br /> Facility Name: Facility Address: Date: <br /> Dollar Tree#02983 2691 N Tracy Blvd Tracy May 28 2019 <br /> -Violation 109 was removed from the report. <br /> -According to Ryan Martinez, Assistant Store Manager, manifests received by the facility for the disposal of <br /> hazardous waste are kept in a file folder in the facility office, and he did not know if copies of the manifests are <br /> sent or mailed anywhere. <br /> Copies of the following manifests numbers were observed on site, but are not on file with DTSC: <br /> -011387308FLE (6/15/18) (IMG 6857) <br /> -012121290FLE (10/31/18) <br /> -012121289FLE (10/31/18) <br /> -013401248FLE (4/3/19) <br /> -013401249FLE (4/3/19) <br /> -013401250FLE (4/3/19) <br /> The generator manifest copy shall be submitted to DTSC for every shipment on a manifest when California is <br /> either the generator state or the destination or consignment state. The generator manifest copy shall be mailed <br /> to: <br /> DTSC Generator Manifests <br /> P.O. Box 400 <br /> Sacramento, CA 95812-0400 <br /> Immediately ensure that copies of all generator manifests have been sent to DTSC within 30 days of shipping <br /> hazardous waste. <br /> -The EHD has written and amended the complete report which replaces the initial checklist on 6/28/2019. <br /> Complete and submit a copy of the Return to Compliance Certification form to the EHD with a statement <br /> documenting the corrective actions that have been or will be taken for each violation, and any supporting <br /> paperwork, by 7/28/2019. <br /> Starting September 1, 2018, all in-office CERS help will be provided at EHD hourly rate ($152). To schedule an <br /> appointment, please call (209)468-3420. <br /> -Provided: Modified Contingency Plan template, List of Free CUPA Training Classes, Return to Compliance <br /> Certification <br /> AFTER THE COMPLIANCE DATE,EHD WILL BILL FOR ALL TIME AND ACTIVITIES ASSOCIATED WITH BRINGING THIS <br /> FACILITY BACK INTO COMPLIANCE. <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHUS CURRENT HOURLY RATE. <br /> Received by: Date: May 28, 2019 Inspector: Inspector Phone: <br /> �M 1 I Printed Name and Title: ELIANNA FLORIDO, REHS (209)468-0343 <br /> yan Martinez,Assistant Store Manager <br /> FA0015793 PR0539178 SC001 05/28/2019 <br /> EHD 22-01 Rev.09/27/2018 Page 15 of 15 Small Quantity Hazardous Waste Generator OIR <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />