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SAN �� IIIN Environmental Health Department <br /> -COUNTY <br /> Greotness grows here. <br /> r. <br /> Corrective Action Statement <br /> RE: July 20, 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. <br /> Also, describe what was done to correct the violation in the space provided below each violation. Submit this <br /> completed form with the Return to Compliance Certification within 30 days of inspection. If you have any questions, <br /> please contact Claudia Muro at(209)561-8923 or cmuro@sjgov.org. <br /> Facility name: Pilot Travel Center Lathrop- 1017 Submit completed form to: <br /> Facility address: 345 Roth Rd SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10726990 ATTN: CLAUDIA MURO <br /> PR0542164 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#105-No emergency coordinator available for emergency response. <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: The Emergency Response Contingency Plan was posted in areas <br /> accessible to staff in the event of a spill. <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: The manifests were located and placed into the appropriate binder <br /> on site. They are attached for your reference. <br /> Violation#117-Failed to submit a written response within 30 days of receiving an inspection report. <br /> M 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: Moving forward,all NOVs will be responded to and a RTC form <br /> provided to the SJCDEH within 30 days. <br /> Page 2 of 3 <br /> 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 />