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SAN JOAQ I Environmental Health Department <br /> Corrective Action Statement <br /> F.E.- , Inspection report <br /> For each vlalatlon Hslced below,Indicate If the vlolatlon has been correcled or w4l3 be correcled tsy a certain cWe. AW, <br /> describe what was clone to corfeci the vlalatlon In the space pTovlded below each vlolallan. Submlt Ihls completed form <br /> with the Return to Cornpllance CerliflcaliDn wliNn 30 days of inspection. If you have any questlons.Please contacl at <br /> or . <br /> Facility name: Submit corriploicd form to, <br /> Feclltty address: SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS JD- none ATTN: <br /> 1&68 E HAZELTON AVENUE <br /> STOCKTON. CA 95205 <br /> This vlalatlon was corrected t7 Thls violation will be corrected by(date); <br /> ❑ Supporting documents included <br /> Deavebe acliona taken or will be laken to correct vlolalic,n: 1-.s � <br /> eo <br /> Jay �l441t 2kr& Ad1 b A -S <br /> Page 2 oll 2 <br /> R84_Q196f�Q7{1 <br /> 1 B68 E. Hazelton Avenue I Stockton, Callfarnla 95205 1 T 209 468.3424 1 r 209 464-4139 I wY w.sjlov.orglEHD <br />