Laserfiche WebLink
SHN , � QA � U � N Environmental Health Department <br /> Hc� �>Iar� u �� <br /> Corrective Action Statement <br /> RE: August 02, 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: H&M - BW#98 Submit completed form to: <br /> Facility address: 2501 JACKSON AVE SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10181511 ATTN: LYNSEY SAMMONS _. <br /> PR0231488 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation #9 -2030002- Leak detection equipment tested by qualified service technician every 12 months <br /> (TCR 9d). <br /> Gr This violation was corrected ❑ This violation will be corrected by (date): <br /> ❑ Supporting documents included <br /> Describe actions taken orwill be taken to correct violation: �t4�t_ 'A�,11 6K CQyy�4,� 1 <br /> Page 2 of 2 <br /> Rev.9/16/2020 <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 />