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Environmental Health Department <br />Corrective Action Statement <br />RE: February 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 />Lynsey Sammons at (209) 616-3067 or lsammons@sjgov.org. <br />SJC ENVIRONMENTAL HEALTH DEPARTMENT <br />ATTN: LYNSEY SAMMONS <br />1868 E HAZELTON AVENUE <br />STOCKTON, CA 95205 <br />Facility name: <br />Facility address: <br />CERS ID: <br />Submit completed form to: <br />10180943 <br />4511 PACIFIC AVE <br />SHOP N GO 3 <br />PR0518326 <br />Violation #2 - 3020001 - Employees thoroughly familiar with all waste handling and emergency procedures. <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: <br />Violation #6 - 3010010 - Signed copy of Uniform Hazardous Waste Manifest kept for 3 years. <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: <br />Page 2 of 2 <br />Rev. 9/16/2020 <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/EHD <br />DO provides Hazardous Waste Training Annually <br />There were no Manifests between 2022 - 2025