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SAN S OA N N Frnvilronmen'W C eafth ©eputirnr ent <br /> Corrective Action Statement <br /> RE: October 01, 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 for <br /> with the Return to Compliance Certification within 30 days of inspection. If you have any questions, please contact <br /> Robert Lopez at(209) 953-6214 or rlopez@sjgov.org. <br /> Facility name: PG&E: Bellota Substation Submit completed form to: <br /> Facility address: 24350 E Flood Rd SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10146533 ATTN:ROBERT LOPEZ <br /> PR0520391 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation##4-Failed to electronically submit the Business Activities or Owner/Operator Identification page. <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: Q CPc-'/2-5 A'S <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 />