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S A N J o A H I N Environmental Health Department <br /> COUNTY <br /> Pilfe. <br /> Corrective Action Statement <br /> RE. February 09, 2021, 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 /> Garrett Backus at(209)468-2986 or gbackus@sjgov.org. <br /> Facility name: MANTECA DENTAL CARE Submit completed form to: <br /> Facility address: 1007 S MAIN ST SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10864561 ATTN: GARRETT BACKUS <br /> PRO546502 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#902-Failed to determine if a waste is a hazardous waste. <br /> ❑ This violation was corrected %This violation will be corrected by(date): —�Lb_512.i;�( <br /> ❑ Supporting documents included <br /> Describe actions taken or will be taken to correct violation: S f (OLS��n `• �( ' <br /> A' rr �1Ct zctrd e ukZ ' o l E' SStt <br /> rr ' n I S b wCR HCl ! IY I YT <br /> IS fl- C l C` {' t k L t ,l '1 r 0-� I - l -ed ' uu a l 0 <br /> Violation#795-Universal Waste Handler failed to keep three years records of each shipment of universal <br /> waste. <br /> 1A 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: in G, �- <br /> Violation#3010-Unlisted Administration/Documentation violation. <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: S+erl CuC I/� _ �►� )l <br /> LLr1-t is ��1•�-'�.,.�t' r t,t/1 `� d if I j `-es:k -:&,r �;d wf- r . <br /> 4-2 <br /> Page 2 of 2 <br /> Rev.9116!2420 <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 />