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- A N11 oII Q Q U N Environmental Health Department <br /> QV !V <br /> Corrective Action Statement <br /> RE: April 15, 2021, Hazardous Materials inspection report <br /> For Bw h violation listed below, indicate if the violation has been corrected or will be corrected by a certain date. Also, <br /> descri what was done to correct the violation in the space provided below each violation. Submit this completed <br /> form wi h the Return to Compliance Certification within 30 days of inspection. If you have any questions, please <br /> conta Carol Presto at(209)616-3061 or cpresto@sjgov.org. <br /> Facilityname: Trinity Parkway AMPM ARCO#83819 Submit completed form to: <br /> Facilityaddress: 10715 Trinity Pkwy SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10760026 ATTN: CAROL PRESTO <br /> PR0543653 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#5-Failed to electronically submit hazardous materials inventory for all reportable materials on site. <br /> M 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: o?2;irdovS <br /> a Onevim.,4-o. 4rc r~� c �, r-► a 4-e•-r a is <br /> Violatio 1#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 /> w1. <br /> Violation#9-Failed to annually review and certify that the HMBP is complete and accurate by the due date. <br /> 113 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: // cc VZ <br /> �r n Ge✓-h' fi�9 4- c /t// Fee '-j- cc, --,Ie r' <br /> GGvr fC_ �e O'Le daK. <br /> Rev.9/16/2020 Page 2 of 3 <br /> 18 t <br /> E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />