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SAN ) O A Q U I N Environmental Health Department <br /> Corrective Action Statement <br /> RE: October 13, 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 for <br /> with the Return to Compliance Certification within 30 days of inspection. if you have any questions, please contact <br /> Robert Lopez at(209)953-6214 or rlopez@sjgov.org. <br /> Facility name: ST JOSEPHS BEHAVIORAL HLTH CTR Submit completed form to: <br /> Facility address: 2510 N CALIFORNIA ST SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10181445 ATTN: ROBERT LOPEZ <br /> PRO519474 1868 E HAZELTON AVENUE <br /> STOCKTON,CA 95205 <br /> Violation#4-Failed to electronically submit the Business Activities or Owner/Operator Identification page. <br /> MII/This violation was corrected ❑This violation will be corrected by(date): <br /> ❑ Supporting documents included r <br /> Describe actions taken or will be taken to correct violation: NEW w ra a/-)A T�®'( <br /> L0111AIrLD AMO Su6t-,OT-10-0• <br /> Violation#5-Failed to electronically submit hazardous materials inventory for all reportable materials on <br /> site. <br /> This violation was corrected ❑This violation will be corrected by(date): <br /> ❑ Supporting documents included ^� <br /> Describe actions taken or will betaken to correct violation: /mj fN"O e f-71 tor✓ UPOATC-0 <br /> AdO 5L/924MMO <br /> Violation#6-Failed to electronically submit a site map with all required content. <br /> IPZhis 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: OW IMUMAMN UPQ)M✓ <br /> ,Ar-CO SU&A IM-10 <br /> Page 2 of 4 <br /> Rev.91162920 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209468-3420 1 F 209464-0138 1 www.sjgov.org/EHD <br />