Laserfiche WebLink
SAN JOAQUIN <br />Environmental Health Department <br />--COUNTY <br />,.. Greotness grows heiv, <br />Corrective Action Statement <br />RE: May 06, 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. 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: BLACK BEAR DINER - LODI Submit completed form to: <br />Facility address: 2347 W KETTLEMAN LN SJC ENVIRONMENTAL HEALTH DEPARTMENT <br />CERS ID: 10711564 ATTN: NICHOLAS LOEHRER <br />PR0535248 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 <br />❑ Supporting documents included <br />❑ This violation will be corrected by (date): <br />Describe actions taken or will be taken to correct violation: <br />Violation #7 - Failed to electronically submit an adequate ER procedures for a release or threatened <br />release. <br />M/ <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 />Violation #9 - Failed to annually review and certify that the HMBP is complete and accurate by the due date. <br />t�3 This violation was corrected ❑ This violation will be corrected by (date): <br />❑ Supporting documents included <br />Rev. 9/16/2020 <br />Describe actions taken or will be taken to correct violation: <br />Page 2 of 3 <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 />