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JOAQUIN <br /> Environmental Health Department <br /> C f Iii f Y <br /> Corrective Action Statement <br /> RE: January 05, 2022, Hazardous!Taste 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 Kristina Saetem at(209)616-3045 or ksaetem@sjgov,org. <br /> Facility name: VAN DE POL ENTERPRISES INC Submit completed form to: <br /> Facility address: 816 E FRONTAGE RD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> Cl_RS 10: 10181513 ATTNt KRISTiNA SAETERN <br /> PRO518100 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <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 /> ET"'Supporting documents included <br /> Describe actions taken or will be taken to correct violation: �i fA,� �C �✓� �, �,J _f <br /> Violation#113-Failed to keep copies of consolidated manifesting receipts for three years. <br /> L,VThis violation was corrected ❑This violation will be corrected by(date): <br /> IYSupporting documents Included <br /> Describe actions taken or will be taken to correct violation: _ <br /> Violation#601 -Stored hazardous waste onsite greater than 180 days(90 days acute/extremely). <br /> 61�This violation was corrected L-3 This violation will be corrected by(date); <br /> O--Supporting documents included <br /> Describe actions taken or will be taken to correct violation: "Ck& beg,Q1 C,, <br /> i iIO1ZZ q 1,&o -Z MA 11SI V - <br /> Page 2 of 3 <br /> Rev,9/1612020 I <br /> 1868 E. Hazelton Avenue Stockton, California 95205 i T 209 468-3420 1 F 209 464-0138 i www.sjgov.org/EHD <br /> I <br /> i <br />