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RECEIVED ON 11/30/2021 VIA EMAIL <br /> SAN .-,JOAO U IN Environmental Health Department <br /> Corrective Action Statement <br /> FSE; Novennber 04, 2021 , Hazardo1_ts t ante inspection report <br /> For each Vloialioln listed below, indicate if the violation has been oxrectad or Ml be 40irected by a celtaln data. AIS4, <br /> describe what was done to correc,the Violation in the space provided below each VIolgon. Submit this completed Form <br /> with the Return to Oampliance Certification within 30 days of inspection, If you have any quiW ons, piease contatt <br /> Vicky Vang-Lee of(209)816-3028 or vvang-tee sjgov,org- <br /> Facility namo= CAL1FORN[A TRACY CONNECT 1NC" Sobmit completed farm to- <br /> f acility address: 610 S CHEROKEE Ln SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> OERS 0' 741841 05 ATTN- ViCKY VANG-1AEE <br /> PRO52484.5 1668 E HAZELTON AVENUE <br /> STOCKTO . OA 95205 <br /> Vola#ion #101 - Managed a hazardous waste vrithout an identification number, <br /> * This violation was corrected Q This vioiation wiii be corrected by(date}; <br /> Supporting documents included <br /> Describe actions taken of will be tate.=to Wrrect Y14I�lticin' <br /> APPLIED FOR EPA 4 ON 11,10021 (SEE ATTACHED APFI ICA-n ON) <br /> Violation #104 -No modified contingency plan. <br /> R This violation was corrected ❑ This violation will be corrected by(date): <br /> ® Supporting documents Included <br /> Des crlbe achons taen c VII Ii be taken t0 Correct viol aton: <br /> Q Qfi DEC IkQ a ND UPDATED CON TINGE No Y NPRIrlTEAND1 TED TFA ILITY B L EI41ERGtt� Y NTA T <br /> LIST ADDED TO OAS HIER ARF- 4 AS WELL., <br /> Vtoiation 4105 -No emergency cwrdInatot avallahie fbr ernergency response. <br /> This vIoiatlan was corrected ❑ This Violation vii II be corrected by (date); <br /> IRI Supporting documents Included <br /> Describe actions Laken OF will be taken to GOTT150 V101AbOr, <br /> MODIFIED CONTINGENCY PLAN COORDINATOR INFORMATION UPDATED AND POSTED AT FACILITY- <br /> (SEE ATTACKED COWnNGENCY PLAN) <br /> Page 2 of 3 <br /> Rev sel&2020 <br /> 1868 E. HazeIton Avenue I iackl:aD r. California 9520 N T 20 486-3420 1 F 209 454-DI 38 1 wvlw.sjgnv.orglEHD <br />