Laserfiche WebLink
li <br /> I <br /> n <br /> r <br /> SAKJAQUiN Environmental Health Department <br /> 4 <br /> -COUNTY-Greatness grows here <br /> Corrective Action Statement <br /> RE: May 07, 2021, Hazardous Materials 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 /> Nicholas Loehrer at(209)468-0623 or nloehrer@sjgov.org. <br /> Facility name: YOSEMITE STREET DIALYSIS CENTER Submit completed form to: <br /> Facility address: 1650 W YOSEMITE AVE BLDG 2 SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10187245 ATTN: NICHOLAS LOEHRER <br /> PR0529195 1868 E HAZELTON AVENUE <br /> STOCKTON,CA 95205 <br /> Violation#4-Failed to electronically submit the Business Activities or Owner/Operator Identification page. <br /> 0-This violation was corrected ❑This violation will be corrected by(date): S ���) Z <br /> ❑ Supporting documents included <br /> Describe actions taken or will be taken to correct violation: i S L-N f SS G vL ©W�1ti/Gt <br /> a t rc-` Tc9 r �c ►� LL,L Jw `fit _- ° r -- c., r.. 4-f 1> <br /> bf .. r Jr. <br /> Violation#5-Failed to electronically submit hazardous materials inventory for all reportable materials on <br /> site. <br /> � <br /> Q' This violation was corrected El This violation will be corrected by(date): ZJy <br /> ❑ Supporting documents included <br /> Describe actions taken or will be taken to correct violation: t �� �. t i L-r v-eJV1 <br /> i <br /> E <br /> Violation <br /> #6-Failed to electronically submit a site map with all required content. <br /> [2'' This violation was corrected ❑This violation will be corrected by(date): ! it <br /> ❑ Supporting documents included ` <br /> Describe actions taken or will be taken to correct violation: . C 111A 1 .\4 <br /> 4- t'lAtAlit- W. :� r' a 14 <br /> Page 2 of 4 <br /> Rev 91162020 <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www,sigov.org/EHD <br />