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SAN J O A n U I N Environmental Health Department <br /> Corrective Action Statement <br /> RE: June 16, 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 Elianna Florido at(209)616-3050 or eflorido@sjgov.org. <br /> Facility name: MY MINI MART Submit completed form to: <br /> Facility address: 1756 N WILSON WAY SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10180819 ATTN: ELIANNA FLORIDO <br /> PR0520571 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#6-Failed to electronically submit a site map with all required content. <br /> Q 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#9-Failed to annually review and certify that the HMBP is complete and accurate by the due date. <br /> yp. 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#11 -Failed to provide or document initial and/or refresher training to appropriate personnel. <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 /> Al <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 />