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x <br /> Environmental Health Department <br /> SANJOAQUIN <br /> "T Y <br /> x <br /> Corrective Action Statement <br /> RE: August 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 Vicky Vang-Lee at(209)616-3028 or vvang-lee@sjgov.org. <br /> Facility name: Airgas USA, LLC Submit completed form to: <br /> Facility address: 3970 WILCOX RD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10166531 ATTN:VICKY /ANG-LEE <br /> PR0519972 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 /> This violation was corrected ❑This violation will be corrected by(date): <br /> ❑ Supporting documents included p <br /> Describe actions taken or will be taken to correct violation: tt)Dr---r- � f��i�An�Ftrl SO.— a.V�r�.. <br /> .!C.tl.r�-1\j4P, i �-� �\--rkAA 1+63 1QL2 0V C;•e�rs E,;Ae, trLP-,sj1nV1AA-A-e6t <br /> �C IATAya <br /> Violation#6-Failed to electronically submit a site map with all required content. <br /> This violation was corrected ❑This violation will be corrected by(date): <br /> �9. Supporting documents included <br /> Describe actions taken or will be taken to correct violation: LJt� �G�(7 ha, <br /> (J �U ' tJ1—Pr"�/ <br /> t)1)rlGkC "1 C U�'1'-f°tom' ' UAIJ Q) J�- rit IMG Q►2( a.A-PP� (� G(4+rLC.�qecA <br /> Violation#9-Failed to annually review and certify that the HMBP is complete and accurate by the due date. <br /> t9 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 Y11'tt at r=-2.VL-P1.,j I V�G1_�5 <br /> ac IV)4f trn (4-f ma;l rf m jyi • y' 'ty 1nrti� kA M P�? LoV1A j2(61-'C- myyrf <br /> nc cw' StiCt-AJt ko tv► yv e,)A ��ke <br /> Page 2 of 3 <br /> Rev.9/16/2020 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sjgov.org/EHD <br />