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4 <br /> 4 <br /> f <br /> [E <br /> ff <br /> Environmental Health Department <br /> SAN JDAQDIN <br /> CbOU N Y....._.. <br /> Cis C f3°25; e.#[it r iif f h, <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(baker@sjgov.org. <br /> Facility name: DELTA BLUEGRASS CO Submit completed form to: <br /> Facility address: 1030 5 ARGONAUT SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10184481 ATTN: LYDIA BAKER <br /> PR0540116 1868 E HAZELTON AVENUE <br /> STOCKTON,CA 95205 <br /> Violations#110-Failed to keep signed copy of manifests from the designated facility for three years. <br /> C8 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 /> G ►�€ 516-tj6J 66PIr5 d r i•• <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 /> B"-Supporting documents included <br /> Describe actions taken or will be taken to correct violation: <br /> Page 2of2 <br /> Rev.812212019 <br /> 1868 E. Hazelton Avenue i Stockton,California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sjcehd.com <br />