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SAN J O A Q U !N Environmental Health Department <br /> Corrective Action Statement <br /> RE.November 24, 2025, inspection rapaft <br /> For earh violation listed heluor,indle-We if the vlolaxn hag been cmnvcted or wit ba correcled by a certain 081e. Alen, <br /> dasolibe what was doM1e W co reV the violalipn in the apace pmvidad below as ch v16ati0M1 Submll Lhj5 wmplelad twm <br /> with the Relurn W Compliarnce CaniricaiJon wMIn 30 days of Inspetrtlon. IF yw have any queaum.,picas*conlecl <br /> 4bdrto Fornxulpz ei(2n)fit&3037 or. <br /> Fadlity name: KFS111D L,GEORGE INC Submit complalad farm 10: <br /> Faclhty addrm! 1725 ACKERMAN DR SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> C RS IC' iD181383 ATTN.AL6ERTC FERNANDE2 <br /> PR0231308 I8B EHAZELTONAVENUE <br /> STflCKTON.CA 95205 <br /> Violation M t D-2030474-Annue I Monttorl nj�System C-ortiiicatlon Form to 11d8 CUPA vvMln 30 day*of <br /> eomptelipn of the[esr- JAI <br /> ❑ This Wolation was corrvstPd 'i"jb1q Wolflion wlw be cormud by(datol. f ,+ <br /> ❑ Supporting dotMmen%Incicded <br /> Elescnpe artrors taken sx will he taken to cprrect%wAation: <br /> YJolationW2-20 100 09-Secondary con[ainmenttestresults submitted to the CUPA with in 30 days after the <br /> lost-- <br /> 11 This violation was sorrect6d ils violation will trig corrected by jda[e): <br /> ❑ Suppor[ingdocu men[a included <br /> Desar a aclions taken 0r wits he Men 10 correel++,Wbon' <br /> Page 2 of 3 <br /> R-W,r.23M <br /> 18$8 E.HaxaII8r4Asrenue i 51DUAon.CalilGmia 1�5n$I T 209 41$$-3420 1 F 2g 464-0133 I ww w.*gw.vr9EF-10 <br />