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f � �f1n1II1 � Environmental Health Department <br /> � U 411 <br /> COUNTY <br /> Greatness grows Fare. <br /> Corrective Action Statement <br /> RE: September 16, 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. <br /> Also, describe what was done to correct the violation in the space provided below each violation. Submit this <br /> completed form with the Return to Compliance Certification within 30 days of inspection. If you have any questions, <br /> please contact Lydia Baker at or Ibaker(o)_sigov.orq. <br /> Facility name: DELTA BLUEGRASS CO Submit completed form to: <br /> Facility address: 1030 S ARGONAUT SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10184481 ATTN: LYDIA BAKER <br /> PR0540116 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 /> ❑ 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#111 -Failed to comply with uniform hazardous waste manifest exception requirements. <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.8/22/2019 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />