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SAN J O A Q U I N Environmental Health Department <br /> - COUNTY - <br /> Corrective Action Statement <br /> RE : September 30 , 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 /> 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 VANG-LEE <br /> PRO519732 1868 E HAZELTON AVENUE <br /> STOCKTON , CA 95205 <br /> Violation #9 - Failed to annually review and certify that the HMBP is complete and accurate by the due date. <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 : D (� ct K= l , l 9- t e. <br /> Violation #11 - Failed to provide or document initial and/or refresher training to appropriate personnel . <br /> 1 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 : + �4 <br /> LID � � c..r\ ix-fa-ws _ <br /> Page 2 of 2 <br /> Rev, 9/16/2020 <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 />