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ANAGAOUIN Environmental Health Department <br /> COUNTY - -• <br /> Corrective Action Statement <br /> RE: June 15, 2021, Hazardous Materials 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: FORMUREX INC Submit completed form to: <br /> Facility address: 2470 N WILCOX RD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10182191 ATTN: GARRETT BACKUS <br /> PRO520003 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#6-Failed to electronically submit a site map with all required content. <br /> [a This violation was corrected ❑This violation will be corrected by(date)- <br /> 0 Supporting documents included <br /> Describe actions taken or will be taken to correct violation: <br /> t �.�. <br /> Violation#8-Failed to establish and electronically submit a reasonable or an adequate training program. <br /> W This violation was corrected ❑This violation will be corrected by(date): <br /> 19 Supporting documents included <br /> Describe actions taken or will be taken to correct violation: i -a k <br /> 6L L <br /> Violation#11 -Failed to provide or document initial andlor refresher training to appropriate personnel. <br /> 3 This violation was corrected ❑This violation will be corrected by(date): <br /> IN Supporting documents included <br /> Describe actions taken or will be taken to correct violation: <br /> No <br /> Rev.9118!2020 Page 2 of 2 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sigov.org/EHD <br />