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� � N � ���� <br /> � � � � � i �� <br /> Corrective <br /> Zlrf' Statement <br /> ^�[][�6�"OV�� Action ~^`.^`^.O���[l^ <br /> RE: May 1Q. 2O25' 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 onrmnt the violation in the space provided below each violation. Submit this completed form <br /> with the Return to Compliance Certification within 3O days of inspection. |f you have any questions, please contact <br /> Allen Aoioat(20S)01O-8U31 oraUen.aeio@sjgov.org. <br /> Facility name: LAFAVDR|TADBAJ AND LMARKET Submit completed form to: <br /> Facility address: 8115O ELDORADO ST GJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CER8 |D: 10180529 ATTN: ALLENAG|O <br /> PR0231503 1M00EMAZELTONAVENUE <br /> STDCKTON. CA95205 <br /> Violation#12-2010009-Secondary containment test results submitted to the CUPA within 30 days after the <br /> test.. <br /> lvTnio violation was corrected O This violation will uo corrected by(uato): <br /> [J Supporting documents includedDescribe actions taken or wi I I be taken to correct violation: Wo to Kt/ all <br /> to W4& 411 tlyMq and frl/,� t rrlOrt-9 arcl PprnjaAd,� <br /> Violation#56-2030013-DO inspections completed at leahi every 30 days and meet all requirements(TCR <br /> 1u). <br /> :/Supporting <br /> isvio|ahonmmsournmtou i�This vio|udonwx|beoornmteuuv(u�a): <br /> douumonts included <br /> Describe actions taken or will be taken to correct violation: M I MU rf f vru/ al i <br /> MOM PIVIVIF RV UH-UAW <br /> Page 2of2 <br /> ne.m's/2ouo <br />