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SAN 10 A Q U I N Environmental Health Department <br /> COUNTY <br /> Gf not /3 <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 vvang-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 YANG- 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 /> , . j11z1 <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 : <br /> yj , ( � L� � � Mn_ cL r\CI <br /> Gl ( J k rtjS - \ L off- <br /> Violation #115 - Failed to retain copy of manifest or bill of lading for spent lead acid batteries for 3 years . <br /> This violation was corrected ❑ This violation will be corrected by (date) : <br /> .4 Supporting documents included <br /> Describe actions taken or will be taken to correct violation : pA ' L <br /> v , d bt/et� <br /> U ) 11 LA) d ,� W n w c, e_ �e� �,� -1- e_r ; e a1� �. rL-E-u� <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 /> 1❑" Supporting documents included ], <br /> Describe actions taken or will be taken to correct violation : �� .� �.0 <br /> Page 2 of 2 <br /> Rev. 9/16/2020 <br /> 1868 E . Hazelton Avenue i Stockton , California 95205 T 209 468- 3420 1 F 209 464-0138 1 www. sjgov. org/EHD <br />