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Environmental Health Department <br /> SH NJ a h Q U IN <br /> Corrective Action Statement <br /> RE: September 03, 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 #11 - 2030048 -Sec containment testing conducted per requirements & records kept for 36 mths <br /> (TCR 9d). <br /> Cir This violation was corrected ❑ This violation will be corrected by (date): <br /> ❑ Supporting documents included "� 1 <br /> Describe actions taken or will be taken to correct violation: CLNiCS OF Q1t W—=A (Xsr.AS <br /> Page 2 of 2 <br /> Rev.9/1612020 <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 />