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N �� Environmental Health Department <br /> - f <br /> Corrective Action Statement <br /> RF- .larniary 24 2092 HA7Firr)nIIR MAtarini5 inetgprtinn ronnrt <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 Submittha <br /> completed form with the Return to Compliance Certification within 30 days of inspection If you have any questions, <br /> please contact Lydia Baker at(209)616-3046 or(baker@s)gov.org. <br /> Facility name: SAVE MART#655 Submit completed form to: <br /> Fnitity aririrrocc 530 W I O[H AVP q.lr':PNOPONIMPNTAI HPAI Tid f)t=RARTM;:NT <br /> CERS ID: 10180587 ATTN:LYDIA BAKER <br /> PR0536640 1868 E HAZELTON AVENUE <br /> STOCKTON,CA 95205 <br /> Violation#6-Fatted to electronically submit a site map with all required content <br /> This violation was corrected ❑This violation will be corrected by(date): <br /> saNNvuiiiy uan.uincnw uitiwucd <br /> Describe actions t en or II be take to orr ct vi lation: <br /> Violation#11 -Failed to provide or document initial and/or refresher training to appropriate personnel. / <br /> ❑ This violation was corrected JX This violation will be corrected by(date): 2,0-ZZ Ct,- , � L <br /> ❑ Supporting documents included ItZ� <br /> Describe actsons taken or will be taken to correct violation. <br /> l•"G'[.{bhAWJ <br /> 2vz <br /> Violation#12-Failed to have the HMBP readily available to facility or EHD personnel, <br /> 11 This violation was corrected ❑This violation will be corrected by(date): <br /> ❑ Supporting documents Included <br /> Oescria actions taken or will be taken to correct violation: <br /> � txUA L � G� r <br /> ultip <br /> Page 2 of 2 <br /> Rev.9116rto20 <br /> 1868 E. Hazeiton Avenue I Stockton,California 952051 T 209 468-34201 F 209 464-0138 1 www.sigov or9/EHD <br />