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4 ��� p Environmental Health Department <br /> 4kr:`: .7CC"� Cht. yfP? 7! $ d`Yt1f . <br /> Corrective Action Statement <br /> RE : January 16 , 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 Lydia Baker at (209) 468-8257 or (baker@sigov. org. <br /> Facility name: FARMINOTON CIRCLE K Submit completed form to: <br /> Facility address: 4469 S ESCALON BELLOTA RD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS 1D: 10187403 ATTN : LYDIA BAKER <br /> PR0540786 1868 E HAZELTON AVENUE <br /> STOCKTON , CA 95205 <br /> Violation #410 - Failed to keep signed copy of manifests from the designated facility for three years . g 9 <br /> VL <br /> This violation was corrected ' 0 This violation will be corrected by (date) _ 'YJ `c3CaC 9>Kf g212 <br /> C1 Supporting documents included 1�3 <br /> Describe actions taken or will be taken to correct violations <br /> Violation #111 - Failed to comply With uniform hazardous waste manifest exception requirements. All <br /> This violation was corrected 0 This violation will bre corrected by (date): jV "t 0 <br /> 13 Supporting documents included <br /> Describe actions taken or will be taken to correct violation: <br /> Violation #605 - Failed to completely label containers or portable tanks of hazardous waste. l / g <br /> This violation was corrected 0 This violation will be corrected by (date): / p iyl <br /> C3 supporting documents included <br /> Describe actions taken or will be taken to correct violation: r <br /> jp <br /> Page 2 of 2 <br /> w. arz��2o� a <br /> 1868 E . Hazelton Avenue i Stockton, California 952051 T 209 468-3420 J F 209 404-0138 i www.sjcehd .com <br /> ZOO / 1. 000d LZbb # 51 3138I0 69L998860Z Z6 : 61, OZOZ / VZ / [ O <br />