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SAN J O A Q U I N Environmental Health Department <br />Corrective Action Statement <br />RE: August 15, 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: PACIFIC AVE Submit completed form to: <br />Facility address: 6131 PACIFIC AVE SJC ENVIRONMENTAL HEALTH DEPARTMENT <br />CERS ID: 10180905 ATTN: LYNSEY SAMMONS <br />PR0519508 1868 E HAZELTON AVENUE <br />STOCKTON, CA 95205 <br />Violation #11 - 1010005 -Site Map with all required content electronically submitted. <br />This violation was corrected <br />❑ Supporting documents included <br />❑ This violation will be corrected by (date): <br />Describe actions taken or will betaken to correct violation: Site Map was updated with all the required elements <br />mentioned in the inspection report and an updated copy was uploaded into CERS for review <br />and approval. <br />Violation #14 - 1020002 -Provided initial and annual training and maintained training records for a minimum <br />of three years. <br />This violation was corrected <br />❑ rtidi <br />❑ This violation will be corrected by (date): <br />Suppong ocuments ncluded <br />Describe actions taken or will be taken to correct violation: On 08/20/24, Refresher training pertaining to <br />chemical spills and hazmat waste was conducted with all staff. New staff will receive this <br />training during their onboarding training and refresher trainings will be held annually. <br />Sign in sheet with list of topics covered during refresher training are attached. <br />Page 2 of 2 <br />Rev. 9/16/2020 <br />1868 E. Hazelton Avenue � Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.org/EHD <br />