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SAN - JOAQUIN Environmental Health Department COUNTY Greatness grows h;• Corrective Action Statement RE: September 10, 2025, inspection report For each violation listed below, indicate if the violation has been corrected or will be corrected by a certain date. Also, describe what was done to correct the violation in the space provided below each violation. Submit this completed form with the Return to Compliance Certification within 30 days of inspection. If you have any questions, please contact Lynsey Sammons at(209)616-3067 or Isammons@sjgov.org. Facility name: GRAPPA MARKET SHELL Submit completed form to: Facility address: 704 N JACK TONE RD SJC ENVIRONMENTAL HEALTH DEPARTMENT CERS ID: 10911469 ATTN: LYNSEY SAMMONS PR0547997 1868 E HAZELTON AVENUE STOCKTON, CA 95205 Violation#3-2010013-Facility has submitted a complete and accurate UST Monitoring Plan.. ❑ This violation was corrected &(This violation will be corrected by(date): 10/04/2025 ❑ Supporting documents included Describe actions taken or will be taken to correct violation: we have submitted our last accepted submittals when we opened our site. Violation#5-2030041 -A current facility plot plan is maintained and has been submitted. ❑ This violation was corrected This violation will be corrected by(date): 10/04/2025 ❑ Supporting documents included Describe actions taken or will be taken to correct violation: Violation#10-2030074-Annual Monitoring System Certification Form to the CUPA within 30 days of completion of the test. ❑ This violation was corrected This violation will be corrected by(date): ❑ Supporting documents included Describe actions taken or will be taken to correct violation: we will keep a note of this and will make sure it will be submitted Page 2 of 5 Rev.9/16/2020 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD