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Corrective Action Statement <br />RE: September 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 form <br />with the Return to Compliance Certification within 30 days of inspection. If you have-, any questions, please contact <br />Jason Gaitan at (209) 468-9848 or jgaitan@slllov.orq. <br />Facility name: BARBOSA CABINETS - LATHROP Submit completed form to: <br />Facility address: 11916 S HARLAN RD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br />CERS ID: 10762441 ATTN: JASON GAITAN <br />PRO544387 1868 E-IAZELTON AVENUE <br />STOCKI'ON, CA 95205 <br />Violation 4108 - Failed to complete, sign or date manifest; or obtain dated signature of transporter. <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 2 <br />Rev. 812W2.01 U <br />1868 E. Hazellon Avenue i Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjc;ehd.cnm <br />