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S A N J O A Q U I N Environmental Health Department <br /> Corrective Action Statement <br /> RE: June 16, 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: BURGER KING #10834 Submit completed form to: <br /> Facility address: 4608 E WATERLOO SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10182263 ATTN: ROBERT LOPEZ <br /> PRO520715 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#4-Failed to electronically submit the Business Activities or Owner/Operator Identification page. <br /> ,E I onhis violation was corrected This violation will be corrected by (date): c4 Irl <br /> ,E3--Supporting documents included <br /> Describe actions taken or will be taken to correct violation: Ph"'L <br /> v dam/ as <br /> Violation#5 - Failed to electronically submit hazardous materials inventory for all reportable materials on <br /> site. <br /> ,fn-'This violation was corrected ['This violation will be corrected by (date): 61/-712 / <br /> AD--Supporting documents included <br /> Describe actions taken or will be taken to correct violation: Sti's �css�.�c �� Cif <br /> WIS ' drl4Ao/ -A, /r0-6rVe- A-,.kL 1rr-ft AS re c Caf-r <br /> Violation #6 - Failed to electronically submit as site map with all required content. <br /> .IT�This violation was corrected A his violation will be corrected by (date): 61712,' <br /> /Supporting documents included <br /> Describe actions taken or will be taken to correct violation: IV" has 6ee-L <br /> ,�10 �.s vd 7'6 If evae s A'Y�A -t- 66 <br /> ..t "V?4 .-e. /e le- Germs.-hA4 -v4os p--e— Ss�� <br /> Page 2 of 3 <br /> Rev.9/16I2020 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 I F 209 464-0138 1 www.sjgov.org/EHD <br />