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SAN J o A Q U I N Environmental Health Department <br />---COUNTY <br />Corrective Action Statement <br />RE: May 10, 2021, Hazardous Materials inspection repos <br />i or 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 Robert Lopez at (209) 953-6214 or rlopez@sjgov.org. <br />Facility name: WESTERN SQUARE INDUSTRIES INC Submit completed form to: <br />Facilitv address: 1621 N BROADWAY AVE SJC ENVIRONMENTAL HEALTH DEPARTMENT <br />CERS ID: 10182849 ATTN: ROBERT LOPEZ <br />PR05198' 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): �1ij15__�� <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: / 1'� /jJf�iO l�p,a4TCo <br />��iolation #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): aM LC24 ZLOCI <br />❑ Supporting documents included <br />Describe actions taken or will be taken to correct violat <br />ion: <br />Paoe 2 ofi 3 <br />Rev. 9/16!2020 <br />1868 E. Hazelton Avenue � Stockton, California 95205 � 7 209 468-3420 � F 209 464-0138 � www.sjgov.org/EHD <br />