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S1If1 �AI Environmental Health Department <br /> -M1 - <br /> 11 V N <br /> C U N T <br /> r Greatness grows here, <br /> Corrective Action Statement <br /> RE: September 19, 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 /> Maria Lopez at(209)616-3064 or melopez@sjgov.org. <br /> Facility name: GRAPPA MARKET SHELL Submit completed form to: <br /> Facility address: 704 N JACK TONE RD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10911469 ATTN: MARIA LOPEZ <br /> PR0547997 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#35-2030065-Interstitial space of the UST is under constant VPH monitoring (TCR 9d). <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: Attached Is the work order. <br /> Violation#56-2030013-DO inspections completed at least every 30 days and meet all requirements(TCR <br /> 12). <br /> ❑ This violation was corrected VThis violation will be corrected by(date): <br /> ❑ Supporting documents included <br /> Describe actions taken or will be taken to correct violation: The DO has used the wrong dates will make . <br /> Sure that the dates are entered would be right. <br /> Page 2 of 2 <br /> Rev.9/16/2020 <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 />