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Corrective Action Statement <br /> RE: October 11 , 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. <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 Paul Nso at (209) 61 &3049 or pnso@sjgov.org . <br /> Facility name : LATHROP SHELL Submit completed form to: <br /> Facility address: 16500 S HARLAN RD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : 10181993 ATTN : PAUL NSO <br /> 1868 E HAZELTON AVENUE <br /> PR0519625 STOCKTON, CA 95205 <br /> Violation #8 - Failed to annually review and certify that the HMBF is complete and accurate by the due date. <br /> W This violation was corrected O This violation wail be corrected by (date): <br /> © Supporting documents included <br /> Describe actions taken or will be taken to correct violation: 1 A rY)2oP SAWLto' WtUw ' ANN(/t -Y <br /> / 49(**a J ANDpt.GlU� Tt li � f3P fin �3 L%/a/.tt17.r <br /> RA rION AX 76 <br /> Page 2 of 2 <br /> Rev. 9/1812020 <br /> .7 '• : \. Sri . ' Ki : : rt i ', ;. jilt ' <'_� I: ; " : .. } . '� I' <br />