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SAN J Q A Q U I N Environmental Health Department <br /> COUNTY <br /> = •ru Greot,ness rgrosys here. <br /> Corrective Action Statement <br /> RE: May 28, 2020, Underground Storage Tank 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 Paul Nso at (209)468-3432 or pnso@sjgov.org. <br /> Facility name: SRH FOOD & GAS Submit completed form to: <br /> Facility address: 749 E DR MARTIN LUTHER KING JR BLVD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10181497 ATTN: PAUL NSO <br /> PR0231060 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#103 - Failure to submit and maintain complete and current financial responsibility documents. <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: C`OIN4-e lc+�N� U?Li;i�rQw� <br /> \<\TC: Ct Z S <br /> Violation #104 - UST operating permit application for facility and tank information not submitted or current. <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 #105 - Failed to have an approved UST monitoring plan. <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: Cbeq-kC-cti� <br /> Page 2 of 4 <br /> Rev.8/27/2019 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />