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Environmental Health Department <br />Corrective Action Statement <br />RE: September 19, 2024, 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 form <br />with the Return to Compliance Certification within 30 days of inspection. If you have any questions, please contact <br />Maria Lopez at (209) 616-3064 or melopez@sjgov.org. <br />SJC ENVIRONMENTAL HEALTH DEPARTMENT <br />ATTN: MARIA LOPEZ <br />1868 E HAZELTON AVENUE <br />STOCKTON, CA 95205 <br />Facility name: <br />Facility address: <br />CERS ID: <br />Submit completed form to: <br />10911469 <br />704 N JACK TONE RD <br />GRAPPA MARKET SHELL <br />PR0547997 <br />Violation #35 - 2030065 - Interstitial space of the UST is under constant VPH monitoring (TCR 9d). <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: <br />Violation #56 - 2030013 - DO inspections completed at least every 30 days and meet all requirements (TCR <br />12). <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: <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 />The DO has used the wrong dates will make . <br />Attached is the work order. <br />Sure that the dates are entered would be right.