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ANJOAQjIN Environmental Health Department <br />COUNTYt1{ <br />"F 4 "YI `i`r {�S$ t i"i.. SS �i f[t ro" <br />Corrective Action Statement <br />RE: June 21, 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. <br />Also, describe what was done to correct the violation in the space provided below each violation. Submit this <br />completed form with the Return to Compliance Certification within 30 days of inspection. If you have any questions, <br />please contact Vicky Vang-Lee at (209) 616-3028 or vvang-lee@sjgov.org. <br />Facility name: HARNEY LANE AM PM Submit completed form to: <br />Facility address: 255 E Harney Ln SJC ENVIRONMENTAL HEALTH DEPARTMENT <br />'ERS ID: 10484500 ATTN: VICKY VANG-LEE <br />PR0537824 1868 E HAZELTON AVENUE <br />STOCKTON, CA 95205 <br />Violation #5 -Failed to electronically submit hazardous materials inventory for all reportable materials on <br />site. <br />0- 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: G �' % 1 S� �aS (� <br />( I'i; 7 t t , y. ,J - L/ L'lf 2 C 41, I"C�'C"("1 h�\A�1(c��s' i7%/ZLn <br />Violation #6 -Failed to electronically submit a site map with all required content. <br />r"91 <br />This violation was corrected <br />❑ ❑ ortindocuments included <br />This violation will be corrected b <br />Suppg <br />Describe actions taken or will be taken to correct violation: <br />Violation #7 -Failed to electronically submit an adequate ER procedures for a release or threatened release. <br />® 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 />d �c,vr-•cam-ti f t' <br />Page 2 of 3 <br />Rev. 9/16/2020 <br />1868 E. Hazelton Avenue I Stockton, California 95205 � T 209 468-3420 � F 209 464-0138 � www.sjgov.org/EHD <br />