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Environmental Health Department <br /> SARJOANINa <br /> COUNTY— <br /> Greotness grows hers~. <br /> Corrective Action Statement <br /> RE: May 03, 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. <br /> Also, describe what was done to correct the violation in the space provided below each violation. Submit this <br /> completed form with the Return to Compliance Certification within 30 days of inspection. If you have any questions, <br /> please contact Lydia Baker at(209) 616-3046 or(baker@sjgov.org. <br /> Facility name: PACIFIC AVE CHEVRON Submit completed form to: <br /> Facility address: 6633 PACIFIC AVE SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10594654 ATTN: LYDIA BAKER <br /> PR0520539 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 /> 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: 15 Ib propane tanks added to Hazardous <br /> Materials Inventory in CERS. <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: Site map has been updated in CERS. <br /> Violation#9-Failed to annually review and certify that the HMBP is complete and accurate by the due date. <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: I will recertify once updated information has been <br /> approved and will do annual renewal prior to due date in the future. <br /> Page 2 of 3 <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 />