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SAN J OAQ U I N Environmental Health Department <br /> Corrective Action Statement <br /> RE: October 07, 2022, 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 form <br /> with the Return to Compliance Certification within 30 days of inspection. If you have any questions,please contact <br /> Nicholas Loehrer at(209)468-0623 or nloehrer@sjgov.org. <br /> Facility name: MCDONALDS#802 Submit completed form to: <br /> Facility address: 4515 PACIFIC AVE SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10180945 ATTN:NICHOLAS LOEHRER <br /> PR0520741 1868 E HAZELTON AVENUE <br /> STOCKTON,CA 95205 <br /> Violation#7-Failed to electronically submit an adequate ER procedures for a release or threatened <br /> release. <br /> X This violation was corrected ❑This violation will be corrected by(date): <br /> ❑ Supporting documents included <br /> ,Describe actions taken or will be taken to ❑rrect violation: <br /> Violation#11 -Failed to provide or document initial and/or refresher training to appropriate personnel. <br /> XThis violation was corrected ❑This violation will be corrected by(date): <br /> ❑ Supporting documents included <br /> Describe actions taken or will be takeAto correct violation: (✓► al,r-L nt ce c,t*—'r <br /> ja z2 17�Ct CQ(a <br /> Page 2 of 2 <br /> Rev.9/16/2020 <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 />