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SAN J OA H I N Environmental Health Department <br /> Corrective Action Statement <br /> RE: June 15, 2021, Hazardous Waste 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 /> Garrett Backus at(209)468-2986 or gbackus@sjgov.org. <br /> Facility name: FORMUREX INC <br /> Submit completed form to: <br /> Facility address: 2470 N WILCOX RD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10182191 ATTN: GARRETT BACKUS <br /> PR0514120 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#102-Failed to determine if a waste is a hazardous waste. <br /> fik This violation was corrected ❑This violation will be corrected by(date): <br /> 0 Supporting documents included <br /> Describe actions taken or will be taken to correct violation: <br /> •y)-Zt 'vim �lC�i c' ►'kcv� �ee✓� ��.�, N <br /> �JJCUII- ALA <br /> Violation#605-Failed to completely label containers or portable tanks of hazardous waste. <br /> R This violation was corrected ❑This violation will be corrected by(date): <br /> IR Supporting documents included <br /> Describe actions taken or will be taken to correct violation: <br /> W--t- �,, -1--c �o <br /> Rev.9/16/2020 Page 2 of 2 <br /> 1868 E. Hazefton Avenue I Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www,sjgov.org/EHD <br />