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SAKJOEnvironmental Health Department <br />Q <br />—COUNT Y <br />Lt: i <br />Greotnesi grows here. <br />Corrective Action Statement <br />RE: September 27, 2023, 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. Also, <br />describe what was done to correct the violation in the space provided below each violation. Submit this completed form <br />with the Return to Compliance Certification within 30 days of inspection. If you have any questions, please contact <br />Michael Suszycki at (209) 598-7001 or msuszycki@sjgov.org. <br />Facility name: MANTECA DENTAL CARE Submit completed form to: <br />Facility address: 1007 S MAIN ST SJC ENVIRONMENTAL HEALTH DEPARTMENT <br />CERS ID: 10864561 ATTN: MICHAEL SUSZYCKI <br />PR0546502 1868 E HAZELTON AVENUE <br />STOCKTON, CA 95205 <br />Violation #102 - Failed to determine if a waste is a hazardous waste. <br />D This violation was corrected This violation will be corrected by (date): 12'� <br />D Supporting documents included <br />Describe actions taken or will be taken to correct violation: <br />�t<< sL-A-1. <br />Violation #106 - Failed to train employees on waste handling and emergency procedures. <br />D This violation was corrected eThis violation will be corrected by (date): <br />D Supporting documents included <br />Describe actions taken or will be taken to correct violation: A \Y1 covr� by <br />11(fiQ-'MO %Af&uAI@a� a.1TL i .../aA_-A&%A <br />Violation #202 - Disposed or caused disposal of hazardous waste at an unauthorized point. <br />kThis violation was corrected ❑ This violation will be corrected by (date): <br />O Supporting documents included <br />Describe actions taken or will be taken to correct violation: YY1POV K. hQWI40is, wAkkl <br />ID coalw o 0 <br />Page 2 of 4 <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 />