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SAN , JOA U I N Environmental Health Department <br />C JtN1TY <br />r 11 <br />Corrective Action Statement <br />RE: April 26, 2021, 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. Also, <br />describe what was done to correct the violation in the space provided below each violation. Submit this completed for <br />with the Return to Compliance Certification within 30 days of inspection. If you have any questions, please contact <br />Robert Lopez at (209) 953-6214 or rlopez@sjgov.org. <br />Facility name: HORIZON OXYGEN &MEDICAL EQUIPMENT Submit completed form to: <br />Facility address: 4079 CALLOWAY CT SJC ENVIRONMENTAL HEALTH DEPARTMENT <br />CERS ID: none ATTN: ROBERT LOPEZ <br />PR0546823 1868 E HAZELTON AVENUE <br />STOCKTON, CA 95205 <br />Violation #2 -Failed to initially complete and electronically submit a HMBP. <br />This violation was corrected This violation will be corrected by (date): May 27, 2021 <br />Supporting documents included <br />Describe actions taken or will be taken to correct violation: The HMBP was submitted via CERS. <br />A Coov has been attached. <br />Violation #3 -Failed to establish and implement a hazardous materials business plan. <br />This violation was corrected This violation will be corrected by (date): May 27, 2021 <br />Supporting documents included <br />Describe actions taken or will betaken to correct violation: The HMBP has been completed and submitted via CERS. <br />A copy has been attached. <br />Violation #4 -Failed to electronically submit the Business Activities or Owner/Operator Identification page. <br />This violation was corrected This violation will be corrected by (date): May 26, 2022 <br />Supporting documents included <br />Describe actions taken or will be taken to correct violation: Has been submitted via CERS. <br />Page 2 of 4 <br />Rev. 9/16!2020 <br />1868 E. Hazelton Avenue � Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.org/EHD <br />