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SAN J O A Q U I N Environmental Health Department <br /> COUNTY . <br /> 1M .4 It Li <br /> Corrective Action Statement <br /> RE : November 18 , 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 /> Vicky Vang- Lee at (209 ) 616-3028 or . <br /> Facility name : GRIN INVESTMENTS INC DBA: ARCO AM/PM Submit completed form to: <br /> Facility address : 6009 N EL DORADO ST SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : 10776040 ATTN : VICKY VANG -LEE <br /> PR0544554 1868 E HAZELTON AVENUE <br /> STOCKTON , CA 95205 <br /> Violation #5 - Failed to electronically 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 : <br /> Biu r, Q-,u -c� %=�D jF ) )'2� S� az <br /> `DIf=S � � ,� L2oal= `e 1\ ( 92t-r17 �(H ( Q 'f ) Cil <br /> Violation #6 - Failed to electronically submit a site map with all required content . <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 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 />