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�{ Environmental Health Department <br /> SAN:JOAQUI N <br /> COUNTY <br /> c, Corrective Action Statement <br /> RE: January 19, 2022, Hazardous materials inspection report <br /> For each violation listed below,indicate if the vlolation has been corrected a 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 Lydia Baker at(209)616-3046 or(baker@sigov.org. <br /> Facility name: Food Maxx#447 Submit completed form to: <br /> Facility address: 610 W Kettleman Ln SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10422145 ATTN:LYDIA BAKER <br /> PRO538671 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 ❑This violation will be corrected by(date): <br /> 17( Supporting documents included <br /> Desc a ctions taken or will be taken to correct violation: <br /> L M Nag LW 421 <br /> Violation#7-Failed to electronically submit an adequate ER procedures for a release or threatened release. <br /> 14, This violation was corrected ❑This violation will be corrected by(date): <br /> ❑ Supporting documents included <br /> Do s cribq actions taken or will be taken o correct i lan -K Ma <br /> .� <br /> i <br /> Violation#11 -Failed to provide or document initial and/or refresher training to appropriate personnel. <br /> )9[ This violation was corrected ❑This violation will be corrected by(date): <br /> Supporting documents included <br /> Describe actio s to en or will be taken to correct violation: <br /> (.[ � <br /> cawn ba 2- <br /> Page <br /> Page 2 of 2 <br /> Rev.9116N020 <br /> 1868 E. Hazelton Avenue i Stockton,California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />