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SAN 10 A Q U I N Environmental Health Department <br /> � C (DLJ N T Y <br /> (, res, tness grows hf , r , <br /> Corrective Action Statement <br /> RE : January 30 , 2020 , Hazardous Waste inspection report <br /> For each violation listed below, indicate if the violation has been corrected or will be corrected by a certain date . <br /> Also , describe what was done to correct the violation in the space provided below each violation . Submit this <br /> completed form with the Return to Compliance Certification within 30 days of inspection . If you have any questions , <br /> please contact John Alaniz at (209) 468-3147 or jalaniz1 @sjgov. org . <br /> Facility name : VAN DE POL ENT INC-PRIMARY Submit completed form to : <br /> Facility address : 4895 S AIRPORT WAY SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : 10185023 ATTN : JOHN ALANIZ <br /> PRO523337 1868 E HAZELTON AVENUE <br /> STOCKTON , CA 95205 <br /> Violation #110 - Failed to keep signed copy of manifests from the designated facility for three years. <br /> ❑ T is violation was corrected ❑ This violation will be corrected by (date) : <br /> supporting documents included <br /> Describe actions taken or will be taken to correct violation : <br /> Violation #111 - Failed to comply with uniform hazardous waste manifest exception requirements. <br /> ❑ his violation was corrected [3 This violation will be corrected by (date) : <br /> supporting documents included <br /> Describe actions taken or will be taken to correct violation : <br /> Page 2 of 2 <br /> Rev. 8/27/2019 <br /> 1868 E . Hazelton Avenue j Stockton , California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www. sjcehd . com <br />