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SH N , O h Q U I N Environmental Health Department <br /> C' CrLJ i1j Y I�1 <br /> Corrective Action Statement <br /> RE: August 02, 2024, 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 /> Lynsey Sammons at (209) 616-3067 or Isammons@sjgov.org <br /> Facility name: H&M - BW#98 Submit completed form to: <br /> Facility address: 2501 JACKSON AVE SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10181511 ATTN: LYNSEY SAMMONS <br /> PR0231488 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation #9 -2030002 - Leak detection equipment tested by qualified service technician every 12 months <br /> (TCR 9d). <br /> Pr 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: CT� t�lS ��K C'G(Q� <br /> ILA f� SIe fu k"&ca Ida 0^ la. -1 Gsl..t raA <br /> IN 3C <br /> Page 2 of 2 <br /> Rev.9/1612020 <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 />