Laserfiche WebLink
05/12/2021 12:16 FAX U0003/0008 <br /> SAN JOAOUIN Environmental HeaKh 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 /> with the Return to Compliance Certificafion 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: Manteca Dialysis Submit completed form to� <br /> Facility address: 1620 W Yosemite Ave SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10733509 ATTN: NICHOLAS LOEHRER <br /> PROS43667 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#4-Failed to electronically submitthe Business Activities or Owner/Operator Identification page. <br /> This violation was corrected D This violation will be corrected by(date): '5112 1Z I <br /> Supporting documents included <br /> Describe actions taken or will be taken to correct vio�ation: &5MI13 kJAhtJ Qy 00JV1 e r <br /> LM0z-)n'(- uunk��f((A� gaw laim svpml'�I-fcL i).C). W5 1,-)-/ <br /> dZESAN�L U U�n�U Irt A —Us JA—E G,1A h oy r&) Sh'217-1 , AnniucAl <br /> ov- ky)gyp B--xn-o UAI N don-e )2�i )Qo iwr encrl <br /> CCA\\tn(AO�V 'itiCkT— 0\-'� a Oan oF Corrtc-hon ' <br /> Violation#5-Failed to electronically submit hazardous materials inventory for all reportable materials on <br /> site. <br /> I)d This violation was corrected 13 This violation will be corrected by(date): .5117,1 Zj <br /> 0 Supporting documents included <br /> Describe actions taken or will be taken to correct violation� UWaYCLL ML-AVAOA),-� I y)VP nto!u <br /> =--Yail woo 'wmilill-tcl :M C <br /> 11 it Cl.a I-A t 0\ CC()M��f (je-i�F�-(CktM C)n S"112W . AnnUod S-Ubmts-�,W <br /> oy k�)9)E' - T-Qyn) W01 IR --dOne L4 )an 1514.OV eCA rictc�r- <br /> 'AeCkK G,,'� 0\ P1 CAV) (9.� C-C)T V1 C-tj bn <br /> Violation#6-Failed to electronically submit a site map with all required content. <br /> This violation was corrected 11 This violation will be corrected by(date): S-112,11.1 <br /> 0 Supporting documents included <br /> Describe actions taken or will be taken to correct vioiation: MOO Wtjh_ G.0 tIUK0 <br /> I A fri) 201YAW b2 M,--� iU dCXLAt6k <br /> -uhL(C&hQ0 on 5-1111 .-Ahaual Yulomtslon �t in-e.)-e FO(r(As <br /> ILI I I k VX LIQU h-,I )(AV) LS% Ov' CLXn. -(211erldal �UrAr rx� a <br /> oc'v) C)�'- comcl-kcP - <br /> Page 2 of 4 <br /> Rev.90612020 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.orq/EHD <br />