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69l lz0-BL0#JS u�nelaled leuo!PN <br /> Environmental Health Department <br /> j . SAN �U <br /> �C AQUIN <br /> UNTY- <br /> �r"t^�'ss qFo,,s ht- <br /> Corrective <br /> t- Corrective Action Statement <br /> For RE: November 23, 2020, Hazardous Materials inspection report <br /> Also a e v1olation listed below, indicate if the violation has been corrected or will be corrected by a certain date. <br /> complete <br /> describe what was done to correct the violation in the space provided below each violation. Submit this <br /> Please d toren with the Return to Compliance Certification within 30 days of inspection. If you have any questions, <br /> c <br /> e ontact Paul Nso at(209)616-3049 or pnso@sjgov.org. <br /> Facility na <br /> me' ABPA GAS FOOD MART Submit completed form to: <br /> Facility address: SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> PERS ID: 1330 E YOSEMITE AVE <br /> 91 ATTN: PAUL NSO <br /> 101841 <br /> 101841 1 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#4-Failed to electronically submit the Business Activities or owner/Operator Identification page. <br /> on <br /> (Q This violation was corrected ❑This violation will be corrected by(date): <br /> ❑ Supporting documents included � ft � <br /> Describe actions taken or will be taken to correct violation: e�'� W�`� / 6 <br /> Violation#5-Failed to electronically submit hazardous materials inventory for all reportable materials on <br /> site. <br /> 0- <br /> 0 This violation was corrected ❑This violation will be corrected by(date): <br /> ❑ Supporting documents included <br /> Describe actions take or wi be taken to correct violation: <br /> Violation#6-Failed to electronically submit a site map with all required content. <br /> This violation was corrected 11 This violation will be corrected by(date): <br /> ❑ Supporting documents included <br /> Describe actions taken or will been to correct violation; <br /> 6 <br /> 00-0$ 3nG 3ONV1WA5e 2 of 4 <br /> Rev.9j16/2020 1868E Hazelton Avenue I Stockton,California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />