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05/12/2021 12:16 FAX ISISAN <br /> U0004/0008 <br /> Environmental Health Department <br /> IIV <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 wi#I 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 /> Manteca Dialysis, 1620 W Yosemite Ave, CERS ID: 10733509, PRO543667 <br /> Violation#12-Failed to have the HMBP readily available to facility or END personnel. <br /> XThis violation was corrected ❑This violation will be corrected by(date): 51x2 Zi <br /> © Supporting documents included <br /> Describe actions taken or will be takers to correct violation: Vn qt enc n)A _2t2n a I n rl"ro <br /> ho eM� tQ admmrmahK on 51141 1 "\ UJ a; <br /> skin �..d k-O Gm 4............P2L4trA L, CcMt a CA rhTiCCAtW Y1 s11z ) . <br /> Oti f�- J' m r e nCq- 9?jVQnXW4 y'1 & 1 <br /> h�'.-�rr��.'h�`!� w t l 1 be G�m n)-C i'c.Gl #�/ �A a UUl I 1 �2 5"�,►�mti�'�(,t � <br /> C 10.J JGn IS4h C)F CGkCh M114f'1C�0�1- \U91,✓ G,5 Pte( 0 <br /> kh$ hlCnn 0� ��`�C�1J�. F-A Will pa 15-0 pnA+ G COPY 0'F <br /> �V)V5 �O(rj) D, p11n1-Q 11 pn �n� GIls17LjBlr�cl!�� fO b� <br /> t iCKGJI Iy r e a (AtI cnbLt, r r rt?vl tui <br /> Page 4 of 4 <br /> Rev.915612026 <br /> 1868 E. Hazelton Avenue E Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sjgov org1EHD <br />