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x I Environmental Health Department <br /> C-OLJNTY <br /> Corrective Action Statement <br /> RE epb�mber 09, 2020, Hazardous MaterW-5 inspeCVOn llepM <br /> For each vitiation IisLed below,indicate if the violallbn has been corrected or will be corracted by a certain date, <br /> Also,describe what was done to correct the violation in the spaace provided below Bach Violation. Submit this <br /> cnmplet.ed Form with the Return to Compllanoe Certification within 30 days of inspection_ IFyou have at)y questions, <br /> Plaase contact Nicholas Loehrer at(209)46B-0623 or nloehrer@sjgov_org. <br /> Facility name, VERIZON V4 ELESS ESCALOU Submit carnpNW forni to= <br /> Facility address, 27052 HM 120 SJC ENVIRONMENTAL HVALTH DEPARTMENT <br /> OERS 10- 10143163 ATTN: NICHOLAS LOEHRER <br /> PR05'i29$6 1888 E HAZELMN AVENUE <br /> STOCKTON, CA 95205 <br /> Violation 96-Failed to electronically submit a 61110 mall with all required eont,erit, <br /> 13 Thie vlolatign was coPrectQd ❑This violation will be corrected by(date): <br /> Supporting documents Included <br /> Desc a actions taken or will be taken to correck violaborl; <br /> Violation 011 -Fal led to provid9 or d0Gum ont InMal andfor refresher training€o appropriate personnet, <br /> 13 This Violation was corrected 11 This Vlolation will be aorracted by(date): <br /> $4..S uppluMng dOGNAMGRts Includsd <br /> Dasoribe actions taken or Will be taken to carr&ct violation; <br /> F)3gs 2 of 2 <br /> 18136 E, Haz�I[on Avenue I Stockton, Oslifornla 95205[ 7 209469-3420 F 209464-0135 www.sjgehd.corn <br />