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S A N J 0 A Q U 1 N Environmental Health Department <br /> RECEIVED 11 /04/2021 VIA EMAIL <br /> Corrective Action Statement <br /> RE: September 30, 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 /> Vicky Vang-Lee at(209)616-3028 or Wang-lee@sjgov.org. <br /> Facility name: Custom Design Manufacturing Submit completed form to: <br /> Facility address: 248 E Kettleman Ln SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10731289 ATTN:VICKY VANG-LEE <br /> PR0513907 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#102-Failed to determine if a waste is a hazardous waste. <br /> I j r>1 <br /> 13 This violation was corrected -431-his violation will be corrected by(date): I <br /> ❑ Supporting documents included 1 <br /> Describe actions taken or will be taken to correct violation: �\ C--0i S N����R4 <br /> c}✓�-�-e-- : rah �-��� ��-�n �°��. ('G���; r� w �� <br /> �= Q i C-.tL(A Ce--c-�---Lc,' V.) 5 t S o <br /> Violation#115-Failed to retain copy of manifest or bill of lading for spent lead acid batteries for 3 years. <br /> ,d 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: V`� & W `\ Yx� n C <br /> ho. C' Cif <br /> Violation#301 -facility not maintained to minimize the release of a hazardous waste. <br /> 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: ` Df S,! �h_�)Lir S D�C,'r (,,� 6/-1 <br /> I ` v G +tr ( . <br /> I Ot S Inc-zoo 1J.� - kms a�La P 1� c <br /> Page 2 of 2 <br /> Rev-9/1612020 <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 />