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Oct 31 22 , 12 : 57p p . 4 <br /> JOAOUIN SAN <br /> Environmental Health Department <br /> Corrective Action Statement <br /> RE: September 08, 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 thig 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) 616-3051 or cpresto@sjgov.org. <br /> Facility name: COUNTRY MART GAS & FOOD Submit completed form to: <br /> Facility address: 34243 S CHRISMAN RD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS 10; /0181085 ATTN : CAROL PRESTO <br /> PRO520448 1868 E HAZELTON AVENUE <br /> STOCKTON , CA 95205 <br /> Violation #t9 - Failed to annually review and certify thatthe HMBP is complete and accurate by the due date. <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: [ LL %/VSAE /+Li PL1�-.f�S <br /> Violation #19 - Failed to submit a certification and written response within 30 days for minor violations. <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 /> 1b1i tipsuA69 ALL e:C94zIIZ6rI- V E WCE1E ,y 12� ? dPr3 #4 � 12JE1u1 <br /> Page 2 of 2 <br /> fiev. 9N BfZ020 ' <br /> 1868 E. Hazelton Avenue J Stockton, California 952051 T 209 468-34201 F 2D9 464-0138 l www. sjgov .orgfEHD <br /> Received Time Sep , 30 , 2021 12 , 42PM No , 6920 <br />