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;AN.t,;xjUAUU1N <br />CQUINITY <br />f , U Ll ,, 3 t 3 ,t <br />Corrective Action Statement <br />RE: June 21, 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: RANCHO SAN MIGUEL MARKET" <br />Facility address: 1427 S AIRPORT WAY <br />'ERS ID: 10184829 <br />P R0524136 <br />Submit completed form to: <br />SJC ENVIRONMENTAL HEALTH DEPARTMENT <br />ATTN: ELIANNA FLORIDO <br />1868 E HAZELTON AVENUE <br />STOCKTON, CA 95205 <br />Violation #6 -Failed to electronically submit a site map with all required content. <br />® This violation was corrected <br />❑ Supporting documents included <br />❑ This violation will be corrected by (date): <br />Describe actions taken or will be taken to correct violation: the Site map haS been COrreCted and Uploaded <br />on CERS. a copy will be sent with the letter of correction. <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: Jesus Jurado Will make Sure the annual <br />HMBP submittal certifaction is submitted by January 15 <br />Violation #11 -Failed to provide or document initial and/or refresher training to appropriate personnel. <br />Rev. 9/16/2020 <br />LI This violation was corrected <br />❑ Supporting documents included <br />❑ This violation will be corrected by (date): <br />Describe actions taken or will be taken to correct violation: all employee's have been trained On the <br />Emergency Response, Spill Notifaction, spill respsonse, Evacuation Procedure. a copy will be sent with <br />the letter of correction. will have copies on site. <br />Page 2 of 2 <br />1868 E. Hazelton Avenue � Stockton, California 95205 � T 209 468-3420 � F 209 464-0138 I www.sjgov.org/EHD <br />