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.s � Environmental Health Department <br /> JL <br /> Corrective Action Statement <br /> RE : January 14 , 2020 , 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 <br /> form with the Return to Compliance Certification within 30 days of inspection . If you have any questions , please <br /> contact Claudia Muro at (209 ) 468-3429 or cmuro@sjgov . org . <br /> Facility name : FWS CONSTRUCTION Submit completed form to : <br /> Facility address : 111 S GUILD AVE SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : 10184473 ATTN : CLAUDIA MURO <br /> PR0524059 1868 E HAZELTON AVENUE <br /> STOCKTON , CA 95205 <br /> Violation #101 - Managed a hazardous waste without an identification number. <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 : Ger . <br /> r ec i eyeA Gf' n n u ng be4pr- <br /> Violation #110 - 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 : <br /> Violation #113 - Failed to keep copies of consolidated manifesting receipts 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 : <br /> Page 2 of 4 <br /> Rev. 8/z ani 9 <br /> 1868 E . Hazelton Avenue ( Stockton , California 95205 1 T 209 468-3420 i F 209 464-0138 1 www , sjcehd . com <br />