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S A NJ 0 A Q U IN Environmental Health Department <br /> i_ COUNTY <br /> '1�.7F�J'AN'.: i,reol'(5c 51 ifi W:'i} hcre. <br /> Corrective Action Statement <br /> RE: June 09, 2020, CaIARP 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 /> Haza Saeed at(209)953-6212 or hsaeed@sjgov.org. <br /> Facility name: MID VALLEY AG SVC Submit completed form to: <br /> Facility address: 15658 ESCALON BELLOTA RD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10411015 ATTN: HAZA SAEED <br /> PR0514764 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#105-Failed to coordinate response actions with local emergency planning and response <br /> agencies(P1). <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 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 />