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SAN J O A Q U I N Environmental Health Department <br /> Corrective Action Statement <br /> RE : September 30 , 2022 , 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 . Also , <br /> describe what was done to correct the violation in the space provided below each violation . Submit this completed <br /> form with the Return to Compliance Certification within 30 days of inspection . If you have any questions , please <br /> contact Paul Nso at (209) 616-3049 or pnso@sjgov . org . <br /> Facility name : MANTECA GROCERY OUTLET Submit completed form to : <br /> Facility address : 1391 E YOSEMITE AVE SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : 10889950 ATTN : PAUL NSO _ <br /> PR0547847 1868 E HAZELTON AVENUE <br /> STOCKTON , CA 95205 <br /> Violation #1 - Failed to pay annual operating fees . <br /> 24 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 /> (�aa 40 .E �.�wjz � 10 3 5S l h-e cymai a 7�� cQ <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 /> ❑ Supporting documents included <br /> Describe actions taken or will be taken to correct violation : <br /> Updated site map with loading docks submitted in CERS on 10/6/2022 <br /> Page 2 of 2 <br /> Rev. 9/16/2020 <br /> 1868 E. Hazefton Avenue I Stockton , California 952051 T 209 468-34201 F 209 464-0138 1 www.sjgov_org/EHD <br />