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05/12/2021 12:16 FAX I U0003/0008 <br /> Kh <br /> tment <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: Manteca Dialysis Submit completed form to: <br /> Facility address: 1620 W Yosemite Ave SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ICJ: 10733509 ATTN: NICHOLAS LOEHRER <br /> PR0543667 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#4-Failed to electronically submit the Business Activities or Owner/Operator Identification page. <br /> This violation was corrected ❑This violation will be corrected by(date): SI IZ 1Z I <br /> © Supporting documents included <br /> Describe actions taken or will be taken to correct violation: &5MI13 kJAhtJ Oy 00Jr1 e r <br /> o <0z '( ' C Yl gaw laim svpml'�I-fcLW <br /> U U K A S iucA <br /> Yl A1 N done )Qo I 0r encrl <br /> CCA\\t?n(A0�r 'tfGr 0\-'� as Oan of Corrccfion <br /> Violation#5-Failed to electronically submit hazardous materials inventory for all reportable materials on <br /> site. I <br /> This violation was corrected ❑This violation will be corrected by(date): SI IZ I Zj <br /> ❑ Supporting documents included <br /> Describe actions taken or will be taken to correct violation: UWaYC nnlak f1G11S Iy)VP nto1 _ <br /> 1 v+ m1 1 C <br /> -i i s a l <br /> v OV r <br /> ` eCkK G� 0\ P1 Gh (9.� cpTn C#j bn <br /> Violation#6-Failed to electronically submit a site map with all required content. <br /> This violation was corrected ❑This violation will be corrected by(date): S112121 <br /> ❑ Supporting documents included <br /> Describe actions taken or will be taken to correct violation: MOO Wt j G.0 f'( 1 1 <br /> t 1-t 201YAW <br /> -uhLCCU 5-1 vrl l <br /> h c 11Q dal <br /> ocnv1 0�'- �com� oP . <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.org/EHD <br />