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SAN J O A Q U I N Environmental Health Department <br /> COUNTY <br /> Grcati) e % s Yrc.v < j: vw' <br /> Corrective Action Statement <br /> RE : September 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. Also, - <br /> describe what was done to correct the violation in the space provided below each violation. Submit this completed form <br /> with the Return to Compliance Certification within 30 days of inspection. If you have any questions, please contact <br /> Nicholas Loehrer at (209) 468-0623 or nloehrer@sjgov.org. <br /> Facility name: HOLT OF CA Submit completed form to: <br /> Facility address: 1234 W CHARTER WAY SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10183655 ATTN: NICHOLAS LOEHRER <br /> PRO512883 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation #5 - Failed to electronically submit hazardous materials inventory for all reportable materials on <br /> site, <br /> 121� This violation was corrected ❑ This violation will be corrected by (date): <br /> ❑ Supporting documents included <br /> Describe actions taken or will <br /> be taken to correct violation: <br /> Cri rbvJ W tTH &Y/ <br /> Violation <br /> d C �Ev v7 Z Iy <br /> �T4 t� CEIZ� C7AF-,, / t.� L lx- I/erc� 7b z&Y <br /> Violation #6 - Failed to electronically submit a site map with all required content. <br /> RT This violation was corrected ❑ This violation will be corrected by (date): <br /> 0 Supporting documents included <br /> Describe actions taken or will be taken to correct violation: S�m nn rc-r 7 <br /> �n.J rrt mtSS fe-J GU ZC Qu .zE' Cn . — <br /> Page 2 of 2 <br /> Rev. 9/16/2020 <br /> 1868 E. Hazelton Avenue i Stockton, California 95205 1 T 209468-3420 1 F 209464-0138 1 www.sjgov.org/EHD <br />