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M � I � Environmental Health Department <br /> u <br /> '- -COUNTY— <br /> Greatness <br /> COUNT <br /> Greatness grows here, <br /> Corrective Action Statement <br /> RE: September 08, 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. Also, <br /> describe what was done to correct the violation in the space provided below each violation. Submit this completed form <br /> with the Return to Compliance Certification within 30 days of inspection. If you have any questions, please contact <br /> Claudia Muro at(209)468-3420 or cmuro@sjgov.org. <br /> Facility name: BLOSSOM FARMS HQ Submit completed form to: <br /> Facility address: 11227E EIGHT MILE RD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10827100 ATTN: CLAUDIA MURO <br /> PR0545404 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#101 -Managed a hazardous waste without an identification number. <br /> ❑ This 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#110-Failed to keep signed copy of manifests from the designated facility for three years. <br /> ❑ This 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#113-Failed to keep copies of consolidated manifesting receipts for three years. <br /> ❑ This 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 /> Page 2 of 3 <br /> Rev.8/18/2020 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />