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N40IIIN Environmental Health Department <br /> I�1 1J <br /> COUNTY <br /> Greotness grows here. <br /> r. <br /> Corrective Action Statement <br /> RE: August 27, 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 Vicky Vang-Lee at(209)616-3028 or vvang-lee@sjgov.org. <br /> Facility name: QUIK STOP MARKET#148 Submit completed form to: <br /> Facility address: 205 W LOCKEFORD ST SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10180641 ATTN:VICKY VANG-LEE <br /> PR0519766 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#6-Failed to electronically submit a site map with all required content. <br /> M This violation was corrected ❑This violation will be corrected by(date): <br /> M Supporting documents included <br /> Describe actions taken or will be taken to correct violation: <br /> Site map has been updated, approved and submitted into CERS. Site map attached. <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 /> HMBP training has been provided. Training records are attached and will be maintained in the Hazardous <br /> Material binder onsite. <br /> Page 2 of 2 <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 />