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GUI. SAN JOAQUIN <br /> �. Environmental Health Department <br /> ►" COUNTY <br /> Greatness grows her,- <br /> Corrective Action Statement <br /> RE: January 26, 2022, 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 Lydia Baker at(209)616-3046 or lbaker@sjgov.org. <br /> Facility name: A&D RUBBER PRODUCTS CO INC Submit completed form to: <br /> Facility address: 1438 BOURBON ST SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10185157 ATTN:LYDIA BAKER <br /> PRO524461 1868 E HAZELTON AVENUE <br /> STOCKTON,CA 95205 <br /> Violation#1 -Failed to pay annual operating fees. <br /> `This violation was corrected O This violation will be corrected by(date): <br /> Supporting documents included <br /> Describe actions taken or will be taken to correct violation: <br /> t� t� 1 tit tY J C} (A Itf �S <br /> Violation#5-Failed to electronically submit hazardous materials Inventory for all reportable materials on <br /> site. <br /> .V 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 violatiyn: <br /> Violation#6-Failed to electronically submit a site map with all required content. <br /> This violation was corrected 13 This violation will be corrected by(date): <br /> ❑ Supporting documents Included <br /> Describe actions taken or will be taken to corre t violation: <br /> '7 ' 44 eA --x <br /> -s,.a � <br /> Page 2 of 3 <br /> Rev 9/1W020 <br /> 1868 E.Hazelton Avenue 1 Stockton,California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />