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SANJOAQUIN <br /> Environmental Health Department <br /> - COUNTY <br /> Corrective Action Statement <br /> RE : October 04 , 2019 , 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: LODI MEMORIAL CEMETERY Submit completed form to: <br /> Facility address: 5750 E PINE ST SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : 10182841 ATTN : CLAUDIA MURO <br /> PR0514008 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 /> 21 This violation was corrected 0 This violation will be corrected by (date ) : <br /> ® Supporting documents included <br /> Describe actions taken or will be taken to correct violation : <br /> DtWo43t> 0 aE Wfrx&� : 'DaLo \Drm, <br /> Violation #113 - Failed to keep copies of consolidated manifesting receipts for three years . <br /> [9 This violation was corrected 0 This violation will be corrected by (date) : <br /> [2 Supporting documents included <br /> Describe actions taken or will be taken to correct violation : <br /> biS SBr� 0E VAAP Z a p 00 5 W (0 �T V4�kt" S L Pctrn d <br /> eD" tG l i? t cy Le W mC4 NA <br /> Violation #406 - Contaminated container not marked with date emptied or managed within one year of being <br /> emptied . <br /> 19 This violation was corrected 0 This violation will be corrected by (date) : <br /> Supporting documents included <br /> Describe actions taken or will be taken to correct violation: <br /> t�- n of L� 150) pT4 i� D Co VT PINeXz-s 10OZ171 I � <br /> Page 2 of 3 <br /> Rev, 8127/2019 <br /> 1868 E . Hazelton Avenue I Stockton , California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www. sjcehd . com <br />