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]OEnvironmental Health Department <br /> SAWCorrective 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 form <br /> with the Return to Compliance Certification within 30 days of inspection. If you have any questions, please contact at <br /> or. <br /> Facility name: Submit completed form to: <br /> Facility address: SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: none ATTN: <br /> 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <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: 14c So <br /> �j;`"`9't1f� /)t��i u2e�3' i��= 7.S`C� �.�/^Po.,,/ �✓,9s�cr °i,�-✓lC ir1. f� r r�v,/�u� - <br /> f9,41fr—O <br /> 5 � �vur 20e��.1 <br /> Page 2 of 2 <br /> Rev.9/16/2020 <br /> 1868 E. Hazelton Avenue Stockton,California 95205 1 T 209 468-3420 F 209 464-0138 1 www.sjgov.org/EHD <br />