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SAN JOAQUIN Environmental Health Department <br /> CC� t � NTti' <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 <br /> form with the Return to Compliance Certification within 30 days of inspection. If you have any questions , please <br /> contact at or , <br /> Facility name: � 6.` c` ' MC4-or Ccr �� Submit completed form to : <br /> w <br /> Facility address: 1115 `� , ( , \0� LGc � gS� 44 SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : none ATTN : C G't'r& i t�' � v T c <br /> O 1 el 51) 61 1868 E HAZELTON AVENUE <br /> STOCKTON , CA 95205 <br /> — This violation was corrected 0 This violation will be corrected by (date) : <br /> 0. Supporting documents included � " n <br /> Describe actions taken or will be taken to correct violation : <br /> ctC 1A ('e kj`Z . le� er � PPt � 4QkC Conz�t� Rf� 0(a \\QAr - .\ s. 0.r.e. <br /> Page 2 of 2 <br /> Rev. 8/27/2019 <br /> 1868 E . Hazelton Avenue I Stockton , California 95205 T 209 468-3420 1 F 209 464-0138 1 www, sjcehd . com <br />