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SAN J a A Q U I N Environmental Health Department <br />r ,i <br />Corrective Action Statement <br />RE: September 24, 2024, 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 />Michael Suszycki at (209) 598-7001 or msuszycki@sjgov.org. <br />Facility name: MITSUBISHI CHEMICALS ADVANCED MATERIALS Submit completed form to: <br />Facility address: 3837 Imperial Way SJC ENVIRONMENTAL HEALTH DEPARTMENT <br />CERS ID: 10401880 ATTN: MICHAEL SUSZYCKI <br />PR0538439 1868 E HAZELTON AVENUE <br />STOCKTON, CA 95205 <br />Violation #6 - 3010010 -Signed copy of Uniform Hazardous Waste Manifest kept for 3 years. <br />E� 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 />Signed copies of manifests from 2021-2024 have been included in the attachment. <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 />