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SAN J O A Q 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. Also, <br />describe what was done to correct the violation in the space provided below each violation. Submit this completed for <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 />Facility name: BURGER KING #10834 Submit completed form to: <br />Facility address: 4608 E WATERLOO SJC ENVIRONMENTAL HEALTH DEPARTMENT <br />CERS ID: 10182263 ATTN: ROBERT LOPEZ <br />PRO520715 1868 E HAZELTON AVENUE <br />STOCKTON, CA 95205 <br />Violation #4 - Failed to electronically submit the Business Activities or Owner/Operator Identification page. <br />,E I onhis violation was corrected This violation will be corrected by (date): c4 Irl <br />,E3 --Supporting documents included <br />Describe actions taken or will be taken to correct violation. <br />PhO^e— A$-.Kl4x-- 74-- hC�S.--dj <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 />,B --Supporting documents included <br />6/1-7/2 <br />Describe actions taken or will be taken to correct violation. Sti's �css�.�c �� 644 <br />Violation #6 - Failed to electronically submit a site map with all required content. <br />.IT�This violation was corrected E --his violation will be corrected by (date): 61712,' <br />/Supporting documents included <br />Describe actions taken or will be taken to correct violation: IV" has 6ee-L <br />�10 As/�i.d� evae s c+. -cap t <br />667- <br />•It "V?4Q -G. I! r(►le- Le/—. -h /VO <br />Page 2 of 3 <br />Rev. 9/16/2020 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sjgov.org/EHD <br />