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� � Environmental Health Department <br /> S A Wel 0 A 0Corrective Action Statement <br /> RE: November 18, 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 Vicky Vang-Lee at(209)616-3028 or vvang-lee@sjgov.org. <br /> Facility name: KISHIDA, GEORGE INC Submit completed form to: <br /> Facility address: 1725 ACKERMAN DR SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10181383 ATTN:VICKY VANG-LEE <br /> 1868 E HAZELTON AVENUE <br /> PR0519915 STOCKTON, CA 95205 <br /> Violation#5-Failed to electronically submit hazardous materials inventory for all reportable materials on <br /> site. <br /> l- 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: `�� �'�`�� � 0 S <br /> br-r 40'0'- . <br /> Violation#6-Failed to electronically submit a site map with all required content. <br /> f!k 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: buBt�tc � Pkv� � h'1OP <br /> 6 tic <br /> Page 2 of 2 <br /> Rev.9116/2020 <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 I www.sjgov.org/EHD <br />