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Cal-EPA DEPARTMENT OF TOXIC SU ANCES CONTROL Allk PETE WILSON,Governor <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 445 N. SAN JOAQUIN STREET/ PO BOX 388 <br /> STOCKTON, CA 95201-0388 <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 /> _ 28. The appropriate local agency has been notified. HSC 25143.10 <br /> 29. Activities claimed under the onsite recycling exemption are appropriate. HSC 25143.2 et sec. <br /> Releases: If there has been a release, provide the following information: number of releases, date(s), type(s) and quantity of <br /> materials/waste, and the cause(s). Use unit sheet or attach additional pages. <br /> YES <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 onsite treatment units? <br /> _ 31. 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, an unauthorized and/or accidental release to the <br /> environment does not include spills contained within containment systems. <br /> This report may identify conditions observed this date that are alleged to be violations of one or <br /> more sections at the California Health and Safety Code (HSC) or the California Code of Regulations, <br /> Title 22 (22 CCR) relating to the management of hazardous waste. The violations may be described in <br /> more detail on the attached note sheets. If any violations are noted, the facility is required to the submit <br /> 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 <br /> submit a revised notification within 30 days to the Department of Toxic Substances Control with a copy <br /> to the local enforcement agency. <br /> Inspector(s): <br /> Lead Inspector: Other Inspector: <br /> Signature: Signature: <br /> Print Name: -)A Print Name: w SE'�Qr <br /> Title: H <br /> �/ E�s <br /> S�itltve �. P. .S.. Title: AeAS-1 ►i 46 SG.� , i� 5a.10, pds-AV <br /> Agency: S.T fo. Pd5-0A1P Agency: CA1G 5-. P. A. a-T-. S. G - 05y <br /> Phone Number: Phone Number:(?i6)Zw- 3 <br /> Facility Representative: <br /> Your signature acknowledges receipt of this report and does not imply agreement with the findings. <br /> Signature: ! Print Name: fa ,% eg Ale 4 <br /> Title: -F-,Iv /Sa-fe f ye MAj e— Date: 3 '3 4r-15. <br /> Onsite Checklist (C) Page � of August 2, 1994 <br />