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Environmental Health Department <br /> J 0 A Q U I N. . <br /> —COUNTY— <br /> Greatness <br /> -COUNTYGreatness grows Melt'. <br /> Corrective Action Statement <br /> RE: October 18, 2019, 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 for <br /> with the Return to Compliance Certification within 30 days of inspection. If you have any questions, please contact <br /> Robert Lopez at (209) 953-6214 or rlopez(d)sigov.orq. <br /> Facility name: JACK IN THE BOX#4406 Submit completed form to: <br /> Facility address: 1916 E MARCH LN SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: none ATTN: ROBERT LOPEZ <br /> PR0542115 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation #2 - Failed to complete and electronically submit a hazardous materials business plan. <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 /> Violation #3 - Failed to establish and implement a hazardous materials business plan. <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 /> Violation #4 - Failed to complete and/or submit the Business Activities or Owner/Operator Identification <br /> page. <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 /> Page 2 of 5 <br /> Rev.8/22/2019 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />