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SA N a AQ U N Environmental Health Department <br />s ..._._...0 OU N T Yu.....,.,. <br />Grco:ness grows herr;. <br />Corrective Action Statement <br />RE: December 15, 2020, Hazardous Materials inspection report <br />For each violation listed below, indicate if the violation has been corrected or will be corrected by a certain date. <br />Also, describe what was done to correct the violation in the space provided below each violation. Submit this <br />completed form with the Retum to Compliance Certification within 30 days of inspection. If you have any questions, <br />Please contact Nicholas Loehrer at (209) 468-0623 or nloehrer@sjgov,org. <br />Facility name: SQUEEZE BURGER <br />Submit completed form to: <br />Facility address: 2742 NAGLEE Rd SJC ENVIRONMENTAL HEALTH DEPARTMENT <br />CERS ID: 10636690 ATTN: NICHOLAS LOEHRER <br />PRO540288 1868 E HAZELTON AVENUE <br />STOCKTON, CA 95205 <br />Violation #2 - Failed to initially complete and electronically submit a HMBP. <br />W 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: I1M-16-P 5 (A)ap I-t-tl-e <br />G-ra-R--SJ <br />Violation #3 - Failed to establish and implement a hazardous materials business plan. <br />6Y This violation was corrected <br />❑ Supporting documents included <br />❑ This violation will be corrected by (date): <br />Describe actions taken or will be taken to correct violation: <br />Violation #4 - Failed to electronically submit the Business Activities or Owner/Operator Identification page. <br />Rev. 9/980020 <br />J' 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: �D QUAryl^eh4-- '1� (&�Vy-s <br />)21 ��R-:� <br />Page 2 of 4 <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 />