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SA N J OA Q U I N Environmental Health Department <br /> Corrective Action Statement <br /> RE: December 03, 2025, 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 /> Kristina Saetern at(209) 616-3045 or ksaetern@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: KRISTINA SAETERN <br /> PR0231488 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation #12 - 2010009 -Secondary containment test results submitted to the CUPA within 30 days after the <br /> test.. <br /> ❑ This violation was corrected ❑ This violation will be corrected by (date): <br /> q+ Supporting documents included \ <br /> Describe actions taken or will be taken to correct violation: S. C\C�.ye Qy-r�lr1.'Yid Q� <br /> COV�� off <br /> obo <br /> Violation #56 - 2030013 - DO inspections completed at least every 30 days and meet all requirements (TCR <br /> 12). <br /> ❑ 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: lk)AN mX <br /> snt's 'eeck�r yo � ���Yr cL\� c�c�s lw Pp4 \Cn Ir)C)`1I f.J\t� <br /> Page 2 of 3 <br /> Rev.9116/2020 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 7 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />