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5 A N J O Q O U I N Environmental Health Department <br /> Corrective Action Statement <br /> RE:April 05, 2022, Hazardous Waste 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)616-3045 or(baker@sjgov.org. <br /> Facility name: 99 Cents Only Stores#177 Submit completed form to: <br /> Facility address: 1120E Hammer Ln SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10440304 ATTN: LYDIA BAKER <br /> PRO538451 1868 E HAZELTON AVENUE <br /> STOCKTON,CA 95205 <br /> Violation#910-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 /> ® Supporting documents included <br /> Describe actions taken or will be taken to correct violation: Manifests available on site. <br /> Page 2 of 2 <br /> Rev.9/16/2020 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420; F 209 464-0138 , www.sjgcv.crg1EHD <br />