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05 / 04 / 2022 09 : 49 FAX Port City Dialysis ( ] 0002 / 0004 <br /> P . <br /> AN € '� A Q ( � Environmental Health Department <br /> Corrective Action Statement <br /> RE : April 27 , 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. Also , <br /> describe what was done to correct the violation in the space provided below each violation . Submit this completed for <br /> with the Return to Compliance Certification within 30 days of inspection . If you have any questions , please contact <br /> Robert Lopez at (209 ) 953-6214 or rlopez@sjgov. org . <br /> Facility name: DaVita Port City Dialysis Submit completed form to : <br /> Facility address : 1810 S FRESNO Ave SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : 10748380 ATTN : ROBERT LOPEZ <br /> PRO542320 1868 E HAZELTON AVENUE <br /> STOCKTON , CA 95205 <br /> Violation #11 - Failed to provide or document initial and /or refresher training to appropriate personnel . <br /> XThis violation was corrected ❑ This violation will be corrected by ( date ) : <br /> 0 Supporting documents included <br /> Describe actions taken or will be taken to correct violation : <br /> Ail twnrnctte5 h�wPi beep in - seryiUa on JcKe aPProprI atm <br /> Afwn (n !j <br /> Page 2 of 2 <br /> Rev. 9/16/2020 <br /> 1868 E . Hazelton Avenue I Stockton , California 952051 T 209 468 - 3420 1 F 209464 -0138 1 www. sjgov . org/EHD <br /> Received Time May , 4 . 2022 9 : 41AM No , 7185 <br />