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SA\I JOAQUIN <br /> Environmental Health Department <br />Corrective Action Statement <br />RE: April 25, 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 <br />form with the Return to Compliance Certification within 30 days of inspection. If you have any questions, please <br />contact Frederick Ernest at (209) 616-3026 or fernest@sjgov.org. <br />Facility name: DAMERON HOSPITAL CORE LABORATORY <br />Facility address: 530 W ACACIA ST <br />CERS ID: 10418239 <br />P R0538676 <br />Submit completed form to: <br />SJC ENVIRONMENTAL HEALTH DEPARTMENT <br />ATTN: FREDERICK ERNEST <br />1868 E HAZELTON AVENUE <br />STOCKTON, CA 95205 <br />Violation #6 - Failed to electronically submit a site map with all required content. <br />id This violation was corrected <br />13-- Supporting documents included <br />0-T-fiis violation will be corrected by (date): <br />Describe actions taken or will be taken to correct violation: <br /> <br />tvea.fdr.-__ <br /> <br />Violation #7 - Failed to electronically submit an adequate ER procedures for a release or threatened release. <br />0 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: <br /> <br />.5‘,44Tiftd 12/, 4//kfte <br /> <br />Violation #9 - Failed to annually review and certify that the HMBP is complete and accurate by the due date. <br />El This violation will be corrected by (date): /11 <br />Describe actions taken or will be taken to correct violation: <br />Zi This violation was corrected <br />0' Supporting documents included <br />Page 2 of 3 <br />Rev. 9/16/2020 <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.org/EHD