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Environmental Health Department <br />Corrective Action Statement <br />RE: August 28, 2025, 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 />Haza Saeed at (209) 953-6212 or hsaeed@sjgov.org. <br />SJC ENVIRONMENTAL HEALTH DEPARTMENT <br />ATTN: HAZA SAEED <br />1868 E HAZELTON AVENUE <br />STOCKTON, CA 95205 <br />Facility name: <br />Facility address: <br />CERS ID: <br />Submit completed form to: <br />10184631 <br />18045 S KELSO RD <br />MOUNTAIN HOUSE CSD WATER TREATMENT <br />PR0519259 <br />Violation #5 - 1010006 - Updated within 30 days of 100% increase or new haz; change of <br />address/owner/name; or change in ops. <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: <br />Violation #10 - 1010004 - Complete and accurate Hazardous Materials Inventory information electronically <br />submitted. <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: <br />Page 2 of 3 <br />Rev. 9/16/2020 <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/EHD <br />The primary contact information in the <br />Emergency Response/Contingency Plan has been updated and submitted to CERS. <br />Separate Hazardous Materials Business <br />Plans were submitted in CERS for the College Park Booster Pump Station and the West Side Booster <br />Pump Station. Lithium ion batteries and potassium permanganate were added to the chemical <br />inventory list in CERS for Mountain House CSD Water Treatment.