UNIFIED PROGRAM INSPECTION REPORT SUMMARY by DerrellAcrey

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									                                       City of Gilroy Chemical Control Program
                                          7351 Rosanna Street, Gilroy, CA 95020
                                           (408) 846-0430 • Fax: (408) 846-0429

                  UNIFIED PROGRAM INSPECTION REPORT SUMMARY

Facility Name                                                                    Address
Contact Person                                                                   Phone
Type of Business
     UNIFIED PROGRAM ELEMENTS                      Program     Inspection            Follow-up                    COMMENTS
                                                   Present     Covered &            Inspection
                                                                  Forms              Required
                                                                 Attached
Hazardous Materials Storage (HMSO only)
Hazardous Materials Business Plan
Risk Management Plan/Cal/ARP
Underground Storage Tank
Aboveground Petroleum Storage Tank
    -SPCC Plan present
Hazardous Waste Generator
    -Large Quantity Generator (LQG)
    -Small Quantity Generator (SQG)
    -Conditionally Exempt (CESQG)
   -Conditionally Authorized (CA)
   -Permit-by-Rule (PBR)

   -Tiered
   -Recycler
Uniform Fire Code Permit
Industrial Wastewater Pretreatment Permit
Permission was granted by a facility representative (initial)
   t Hazardous Waste Violations: Submit Certification of Correction within 30 days. To do this return the pink
     copies of the Hazardous Waste Generator Report and this Summary page. Sign below that you certify that
     the hazardous waste violations were corrected as required. For items that will take longer than 30 days
     submit an action plan with proposed dates for correction within 30 days. Minor hazardous waste violations
     not corrected within 30 days become Class II violations and an NOV will be issued. Uncorrected Class II
     violations can become Class I violations. Class I violations are subject to administrative penalties or referral
     to the DA for Prosecution. Failure to return pink copy with corrected violations will subject the business to
     re-inspection fees.
   t I Hereby Certify that I have corrected the hazardous waste violations identified on the inspection
     report attached. t A corrective action plan is attached for some items.
   Signed:______________________________Title :_____________________________Date:___________

                                DATE TO INSPECT           DATE COMPLETED                           ENFORCEMENT ACTION
t FOLLOW-UP
INSPECTION REQUIRED                                                                        Warning / NOV / AEO / DA Referral / Citation

   Date               Inspector Signature                         Facility Contact                             Facility Signature




                       DISTRIBUTION:       White - FILE      Yellow - FACILITY               Pink – FACILITY

								
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