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1 S A N J O A O U IN Environmental Health - _ � DEC 01 2M ENVIRONP.ILNTAL HEALTH Corredki4'A'6666i EStatement RE: November 03, 2020, Hazardous Materials inspection report For each violation listed below, indicate if the violation has been corrected or will be corrected by a certain date. Also, describe what was done to correct the violation in the space provided below each violation. Submit this completed form with the Return to Compliance Certification within 30 days of inspection. If you have any questions, please contact Stacy Rivera at or srivera(a)slgov.orq. Facility name: CHARTER WAY SHELL' Submit completed form to: Facility address: 620 W DR MARTIN LUTHER KING JR BLVD SJC ENVIRONMENTAL HEALTH DEPARTMENT CERS ID: 10181363 ATTN: vci r+v� Le c? C V is(b PRO519929 1868 E HAZELTON AVENUEU STOCKTON, CA 95205 Violation#5-Failed to electronically submit hazardous materials inventory for all reportable materials on site. B'-This violation was corrected ❑This violation will be corrected by(date): ❑ Supporting documents included Describe actions taken or will be taken to correct violation: H 1 @ h r �9QA011ie, QTS+C-el ho Oe" r Violation#6-Failed to electronically submit a site map with all required content. C This violation was corrected ❑This violation will be corrected by(date): ❑ Supporting documents included Describe actions taken or will be taken tocorrect violation: C'F' Violation#8-Failed to establish and electronically submit a reasonable or an adequate training program. This violation was corrected ❑This violation will be corrected by(date): LS Supporting documents included Describe actions taken or will be taken to correct violation: J�U J�'l 1 Page 2 of 3 -w 8/27/2019 1868 E. Hazelton Avenue 1 Stockton. California 952051 T 209 468-3420 1 F 209 464-0138 1 www.s;cz-i-.;