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SAN J 0 An I N Environmental Health Department <br />COU NTY <br />Greotness grows here. <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. <br />Also, describe what was done to correct the violation in the space provided below each violation. Submit this <br />completed form with the Return to Compliance Certification within 30 days of inspection. If you have any questions, <br />please contact at or. <br />Facility name: <br />Facility address: <br />CERS ID: none <br />This violation was corrected <br />00 Supporting documents included <br />Submit completed form to: <br />SJC ENVIRONMENTAL HEALTH DEPARTMENT <br />ATFN: <br />1868 E HAZELTON AVENUE <br />STOCKTON, CA 95205 <br />❑This violation will be corrected by (date): <br />Describe actions taken or will be taken to <br />U�e <br />Page 2 of 2 <br />Rev. 9/16/2020 <br />1868 E. Hazelton Avenue � Stockton, California 95205 � T 209 468-3420 � F 209 464-0138 � www.sjgov.org/EHD <br />