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� I'i Environmental Health Department <br /> C0U1NTY <br /> Corrective Action Statement <br /> RE: June 05, 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: HARNEY LANE AM PM Submit completed form to: <br /> Facility address: 255 E Harney Ln SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10484500 ATTN: KRISTINASAETERN <br /> PR0537549 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#3-2010013-Facility has submitted a complete and accurate UST Monitoring Plan.. <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: Cc,r—f-( "- , +✓ �1 j�/`C-1'r 16^2 <br /> C_ ''1" rcciaC'i"7-i h/ C/ell <br /> n C 6:,f G'� '`)d n c-I�/� e-4/ oe!— 2�d cy r710 �¢ <br /> of c;G i-I c,'--/? 'r <br /> Violation#10-2030074-Annual Monitoring System Certification Form to the CUPA within 30 days of <br /> completion of the test. <br /> g This violation was corrected ❑This violation will be corrected by(date): <br /> ❑ Supporting documents included Describe actions taken or will be taken to correct violation: l� O�4y e 4-e O'/ <br /> F-2 40 <br /> 6-,y750 r e 4--e-r� -7 a a"0/ 06:� +er* <br /> C-2�Or—dcr' a r-e, 04 I h -P -7 er. <br /> Page 2 of 5 <br /> Rev.9/1 612 0 2 0 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 i T 209 468-3420 1 F 209 464-0138 1 www.sigov.org/EHD <br />