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Environmental Health Department <br />Corrective Action Statement <br />RE:April 12,2021, 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 />Robert Lopez at (209)953-6214 or rlopez@sjgov.org. <br />SJC ENVIRONMENTAL HEALTH DEPARTMENT <br />ATTN:ROBERT LOPEZ <br />1868 E HAZELTON AVENUE <br />STOCKTON, CA 95205 <br />Facility name: <br />Facility address: <br />CERS ID: <br />Submit completed form to:Michael's New York Style Pizza, Inc <br />10734148 <br />2300 W Alpine Ave <br />PR0541594 <br />Violation #4 - Failed to electronically submit the Business Activities or Owner/Operator Identification page. <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 />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 />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 | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/EHD