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SAN J 0 AQ U I N Environmental Health Department <br /> Y <br /> 6'eotness lor0us here, <br /> Corrective Action Statement <br /> RE: July 20, 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 /> Haza Saeed at(209)953-6212 or hsaeed@sjgov.org. <br /> Facility name: JACOBS MALCOLM&BURTT Submit completed form to: <br /> Facility address: 645 N STOCKTON ST SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10183563 ATTN: HAZA SAEED <br /> PR0520325 1868 E HAZELTON AVENUE <br /> STOCKTON,CA 95205 <br /> Violation#9-Failed to annually review and certify that the HMBP is complete and accurate by the due date. <br /> ❑ This violation was corrected ❑This violation will be corrected by(date): <br /> FSupporting documents included <br /> /Describe actions taken or will be taken to correct violation: wtll cye4e d 1,444emof �h C•ww(Y unYh <br /> Violation#11 -Failed to provide or document initial and/or refresher training to appropriate personnel. <br /> /111 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: �VYtinrnn ,,,tiS �« er►�(n ins <br /> Page 2 of 2 <br /> Rev.9/16/2020 <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sigov.org/EHD <br />