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SAN oA Q N Environmental Health Department <br /> c0UNTv <br /> Corrective Action Statement <br /> RE : September 24, 2020 , 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 form <br /> with the Return to Compliance Certification within 30 days of inspection. If you have any questions, please contact <br /> Frederick Ernest at (209) 616-3026 or fernest@sjgov.org. <br /> Facility name: DELTA BLUEGRASS CO Submit completed form to: <br /> Facility address: 1030 S ARGONAUT SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10184481 ATTN: FREDERICK ERNEST <br /> PR0521045 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation #4 - Failed to electronically submit the Business Activities or Owner/Operator Identification page. <br /> -�9— This violation was corrected 0 This violation will be corrected by (date): <br /> .. Supporting documents included <br /> Describe actions taken or will be taken to correct violation: <br /> Violation #5 - Failed to electronically submit hazardous materials inventory for all reportable materials on <br /> site. <br /> J24- This violation was corrected 0 This violation will be corrected by (date): <br /> 0- Supporting documents included <br /> Describe actions taken or will be taken to correct violation: <br /> Violation #6 - Failed to electronically submit a site map with all required content. <br /> This violation was corrected 0 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 4 <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 />