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S A N 1 O A Q U f N Environmental Health Department <br /> Cn C-)L J Ni i Y <br /> t.ssr•17fi?ess i�i .. Er •I , <br /> Corrective Action Statement <br /> RE: , 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 farm <br /> with the Return to Compliance Certification within 30 days of inspection. If you have any questions,please contact at <br /> or. <br /> Facility name: Submit completed form to: <br /> Facility address: 5JC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: none ATTN: <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON,CA 95205 <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: xt!ro L s <br /> —/Y-b CI?e:L/la..t!01. <br /> 2cseL-1elt- <br /> ��E1,2f� � E� <br /> Page 2 of 2 <br /> Rev.Of1612020 <br /> 1868 E. Hazelton Avenue i Stockton,California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHO <br />