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Environmental Health Department <br /> SAN JOAQUIN <br /> COUNlY <br /> Corrective Action Statement <br /> RE: May 24, 2023, 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 Michael Suszycki at (209)598-7001 or msuszycki@sjgov.org. <br /> Facility name: A&A GAS FOOD MART Submit completed form to: <br /> Facility address: 1330 E YOSEMITE AVE SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10184191 ATTN.- MICHAEL SUSZYCKI <br /> PRO520871 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 wiilrll be taken to correct violation: <br /> rl <br /> Violation#9-Failed to annually review and certify that the HMBP is complete and accurate by the due date. <br /> 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: 141--C 1—j-1 'l !� S�"�� <br /> Cf /I 4� of s 42 e <br /> Violation#11 -Failed to provide or document initial and/or refresher training to appropriate personnel. <br /> H 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: <br /> gve <br /> Page 2 of 3 <br /> Rev 911612020 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www,sigov.org/EHD <br />