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S A N 1 O A Q U I N Environmental Health Department <br />Corrective Action Statement <br />RE: June 12, 2024, 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 />Lynsey Sammons at (209) 616-3067 or Isammons@sjgov.org. <br />Facility name: California Materials, INC <br />Submit completed form to: <br />Facility address: 3736 S HWY 99 SJC ENVIRONMENTAL HEALTH DEPARTMENT <br />CERS ID: 10456468 ATTN: LYNSEY SAMMONS <br />PR0519493 1868 E HAZELTON AVENUE <br />STOCKTON, CA 95205 <br />Violation #5 -1010006 - Updated within 30 days of 100% increase or new haz; change of <br />address/owneriname; or change in ops. <br />\k-7 This violation was corrected ❑This violation will be corrected by (date): <br />`EI Supporting documents included <br />Describe actions taken or will be taken to correct violation: <br />Violation #10 -1010004 -Complete and accurate Hazardous Materials Inventory information electronically <br />submitted. <br />\\] This violation was corrected ❑ This <br />Rev, 0/1612020 <br />violation will be corrected by (date): <br />2 Supporting documents included ��(�C� <br />Describe actions taken or will be taken to correct violation: _1__l J� <br />Page 2 of 3 <br />1868 E. Hazelton Avenue � Stockton, California 95205 � T 209 468-3420 � F 209 464-0138 � www.sjgov.orglEHD <br />