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�% Environmental Health Department <br /> S A Wd 0 A Q U I N <br /> Great grows mere. <br /> Corrective Action Statement <br /> RE: March 30, 2022, 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 Robert Lopez at (209) 953-6214 or rlopez@sjgov.org. <br /> Facility name: CREEKSIDE CARE CENTER Submit completed form to: <br /> Facility address: 9107 N DAVIS RD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10184127 ATTN: ROBERT LOPEZ <br /> PRO520784 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 /> 'Lx 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: &AX, a119- <br /> ffl,r _ c5al7/ f1 Zk- -Cr <br /> hndo:; 05 n20 1 A S <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 /> ❑ Supporting documents included �/ <br /> Describe actions taken or will be taken to correct violations: 5-j ,r-- L� <br /> 40 )n dlz 2�fc S 1 I rrA koad a cce.s a"?Z <br /> G f -e c l) <br /> Violation#10 - Failed to electronically update the HMBP within 30 days of substantial change in operations. <br /> xThis 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: 6� &0as- <br /> Page 2 of 3 <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 />