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SANi n I h� Environmental Health Department . �ircoCrCSi �rr,� ar5 a't�r+i Corrective Action Statement RE: July 12, 2022, Hazardous Materials inspection report For each violation listed below, indicate if the violation has been corrected or will be corrected by a certain date. Also, describe what was done to correct the violation in the space provided below each violation. Submit this completed form with the Return to Compliance Certification within 30 days of inspection. If you have any questions, please contact Gabriela Garcia-Mejia at(209)616-3037 or ggarcia-mejia@sjgov.org. Facility name. DA Archer Excavating Submit completed form to: Facility address: 1819 S ARGONAUT ST SJC ENVIRONMENTAL HEALTH DEPARTMENT CERS ID: 10786141 ATTN: GABRIELA GARCIA-MEJIA PR0519449 1868 E HAZELTON AVENUE STOCKTON, CA 95205 Violation#5-Failed to electronically submit hazardous materials inventory for all reportable materials on site. This violation was corrected ❑ This violation will be corrected by(date): ❑ Supporting documents included Describe actions taken or will be taken to correct violation: rno c. t-n!; ki—t yr rA Correcfy ory LycI-L b,,I� Violation#9-Failed to annually review and certify that the HMBP is complete and accurate by the due date. I This violation was corrected ❑This violation will be corrected by(date): ❑ Supporting documents included Describe actions taken or will be taken to correct violation: CC>rriec �7v/2 c Violation#11 -Failed to provide or document initial and/or refresher training to appropriate personnel. [� This violation was corrected ❑This violation will be corrected by(date): ❑ Supporting documents included Describe actions taken or will be taken to correct violation: i'YlUUC.rI! 'Urw��7�1 �'.Urr�� 10IZi r,,c1LLC Page 2 of 3 Rev.9/16/2020 1868 E. Hazelton Avenuo I Stockton, California 96206 1 T 200 468-3420 1 F 209 464-0138 1 www sjc3ov org/FHD