Laserfiche WebLink
S A N , O A Q U I N 'Environmental Health Department <br /> Corrective Action Statement <br /> RE: September 11, 40-45, 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 /> Aaron Madera at(209)516-3065 or amadera@sjgov.org. <br /> Facility name: ST JOSEPHS HOSPITAL Submit completed form to: <br /> Facility address: SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10181391 A.TTN:AARON MADERA <br /> PR0231036 1868 E HAZELTON AVENUE <br /> STOCKTON,CA 95205 <br /> Violation#8-2010016-"Underground Storage Tank Statement of Understanding and Compliance Form" <br /> submitted (TCR 10). <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: QW 6e-D A p p j2`65S <br /> C-IPLOA/ D 70 ot-+RS <br /> Violation#10-2030074-Annual Monitoring System Certification Form to the CUPA within 30 days of <br /> completion of the test. <br /> ❑ This violation was corrected ❑This violation will be corrected by(date): <br /> ❑ Supporting documents included + �1 <br /> Describe actions taken or will be taken to correct violation: �[''POU Lit lt N y�X0(1- A&q <br /> 'TUgm6l W drJ MM� WE callw AL6o 0;-AQLE CgdC44. OCR <br /> �JFKO-W, AAEAL 146015 ,'ROrz <br /> Page 2 of 3 <br /> tev.e11812020 <br /> 1868 E. Hazelton Avenue j Stockton,California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />