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SAN J 0 AQ U IN Environmental Health Department <br /> Corrective Action Statement <br /> RE: September 27, 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 <br /> form with the Return to Compliance Certification within 30 days of inspection. If you have any questions,please <br /> contact Nicholas Loehrer at(209)468-0623 or nloehrer@sjgov.org. <br /> Facility name: 7-ELEVEN INC.STORE#20304 Submit completed form to: <br /> Facility address: 455 W GRANT LINE AVE SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10464166 ATTN: NICHOLAS LOEHRER <br /> PR0539388 1868 E HAZELTON AVENUE <br /> STOCKTON,CA 95205 <br /> Violation#5-Failed to complete and/or submit hazardous materials inventory for all reportable materials on <br /> site. <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: UPJA l C E R5 W 141 t� WE <br /> 1) /MGA+1Jn 42- 41C 1415 = Drijelclwdlod ugd."41A6ke <br /> S�k F" 2-V ZD S1401"I's s,AO C�P_s k4 ! 1Y laza <br /> Page 2 of 2 <br /> Rev 8/27/2019 <br /> 1868 E. Hazelton Avenue I Stockton,California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www sjcehd com <br />