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RUEnvironmental Health Department <br /> »_ <br /> sh Corrective Action Statement <br /> RE: October 03, 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 Christine Lawrence at(209)468-3562 or clawrence@sjgov.org. <br /> Facility name: DOCTORS HOSPITAL OF MANTECA Submit completed form to: <br /> Facility address: 1205 E NORTH ST SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10180669 ATTN: CHRISTINE LAWRENCE <br /> PR0516298 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#102-Failed to determine if a waste is a hazardous waste. <br /> C9' 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: t✓GS os- <br /> Violation#109-Failed to send generator manifest copies to DTSC within 30 days. <br /> Q-'This violation was corrected ❑This violation will be corrected by(date): <br /> W Supporting documents included <br /> Describe actions taken or will be taken to correct violation: VICyu\nT--; <br /> Violation#110-Failed to keep signed copy of manifests from the designated facility for three years. <br /> O This violation was corrected 0 This violation will be corrected by(date): <br /> 0 Supporting documents included <br /> Describe actions taken or will be taken to correct violation: G.�.c. 'L .50 <br /> c.�k 1+�si��.� Q&- <br /> Page <br /> &-Page 2 of 3 <br /> Rev.8/27/2018 <br /> 1868 E. Hazelton Avenue J Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />