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S A NJ 0 A Q I N Environmental Health Department <br />Corrective Action Statement <br />RE: July 20, 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 <br />form with the Return to Compliance Certification within 30 days of inspection. If you have any questions, please <br />contact Carol Presto at (209) 616-3061 or cpresto@sjgov.org. <br />Facility name: H&M - BW #98 <br />Submit completed form to: <br />Facility address: 2501 JACKSON AVE <br />SJC ENVIRONMENTAL, HEALTH DEPARTMENT <br />CERS ID: 10181511 <br />ATTN: CAROL PRESTO <br />PRO520593 <br />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: <br />Violation #6 - Failed to electronically submit a site map with all required content. <br />0 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 />❑ This violation was corrected ❑ This violation will be corrected by (date): <br />❑ Supporting documents included <br />Describe actions taken or will be i <br />4 C_` <br />Page 2 of 3 <br />Rev. 9/1612020 <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 />