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_..� ,.-.. a­ , m <br /> SANt _ JOAQUIN Environmental Health Department <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 /> E with the Return to Compliance Certification within 30 days of inspection, if you have any questions,please contact <br /> i 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 /> Pft0529195 1868 E HAZELTON AVENUE <br /> i STOCKTON,CA 95205 <br /> Violation#4-Failed to electronically submit the Business Activities or Owner/Operator Identification page!. <br /> a---Thi.violation was corrected ❑This violation will be corrected by(date): <br /> ❑ Supporting documents Included <br /> i <br /> Describe actions taken or will be taken to correct violation: <br /> Violation#5-Failed to electronically submit hazardous materials inventory for all reportable materials on <br /> site. <br /> 0 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 <br /> 96-Failed to electronically submit a site map with all required content. <br /> GY This violation was corrected ❑This violation will be corrected by(date); ._' ... <br /> ❑ Supporting documents included <br /> 4 <br /> Describe actions taken or will be taken to correct violation <br /> Y <br /> J..=Sg��t-� Us.-- 3 i V'. ! , 3 v,�} ` r.;.' ! l j>v'1'l-r_ �.-t L.�it S!.• � CS <br /> l <br /> Page 2 of 4 <br /> r?a�rr,�rza� <br /> 1868 E Hazelton Avenue Stockton,California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />