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Q N a N Environmental Health Department <br /> 1 ►�• = i - - C0U1\JTY <br /> Corrective Action Statement <br /> RE : November 18 , 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 /> Vicky Vang- Lee at (209 ) 616-3028 or . <br /> Facility name : GRIN INVESTMENTS INC DBA: ARCO AM/PM Submit completed form to : <br /> Facility address : 6009 N EL DORADO ST SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : 10776040 ATTN : VICKY VANG- LEE <br /> PR0544555 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 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 : C3� a I � rr ti <br /> S l 1 le ( -� s '� 4 ,mss <br /> Violation #111 - Failed to comply with uniform hazardous waste manifest exception requirements . <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 : SO 6 KJU�D COZ) �1 6 r T /"i c <br /> Q ISL �S (,� C►-�-- <br /> Page 2 of 2 <br /> SII Rev. 9/16/2020 <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 />