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SAN �� IIIN Environmental Health Department <br /> -COUNTY <br /> Greotness grows here. <br /> r. <br /> Corrective Action Statement <br /> RE: December 02, 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 Gabriela Garcia-Mejia at(209)616-3037 or ggarcia-mejia@sjgov.org. <br /> Facility name: CHEFSTORE#7517 Submit completed form to: <br /> Facility address: 6502 Pacific Ave SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10456801 ATTN: GABRIELA GARCIA-MEJIA <br /> PR0539383 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 /> IX This violation was corrected ❑This violation will be corrected by(date): <br /> IR Supporting documents included <br /> Describe actions taken or will be taken to correct violation: This action was corrected December 13, 2021 <br /> by working with our 3rd party hazardous waste disposal provider to obtain past due Copies of all <br /> hazardous waste manifests and universal waste bills of lading. <br /> Violation#712-Universal Waste Handler failed to label universal waste. <br /> IX This violation was corrected ❑This violation will be corrected by(date): 12/13/2021 <br /> lel Supporting documents included <br /> Describe actions taken or will be taken to correct violation: On December 13, 2021, the store manager was <br /> provided access to the Universal Waste label template to be printed and affixed to the universal <br /> waste container. This document is also available to all CA store managers in a shared <br /> network drive to be printed and filled out upon each annual pickup. <br /> Violation#715-Universal Waste Handler failed to keep three years records of each shipment of universal <br /> waste. <br /> CX This violation was corrected ❑This violation will be corrected by(date): 12/13/2021 <br /> ❑ Supporting documents included <br /> Describe actions taken or will be taken to correct violation: There are currently no universal waste manifests <br /> or bills of lading as the waste in question is handled by either: the electrical company providing <br /> bulb and/or ballast changes; or US Foods corporate for a-waste (in order to wipe hard drives and <br /> protect sensitive/confidential information. A standard universal waste program for all US <br /> Foods CHEF'STOREs nationwide is being written to comply specifically to CA and Federal universal waste <br /> regulations. <br /> Page 2 of 2 <br /> Rev.9/16/2020 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />