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SAN SLFJOAQUIN <br /> Environmental Health Department <br /> C r_) U I\l T 1 <br /> Corrective Action Statement <br /> RE : February 25 , 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 : A G SPANOS AVIATION DEPT* Submit completed form to : <br /> Facility address : 4800 S AIRPORT WAY SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : 10181439 ATTN: PAUL NSO <br /> PR0231509 1868 E HAZELTON AVENUE <br /> STOCKTON , CA 95205 <br /> Violation #113 - Failure to submit " Monitoring System Certification Form " within 30 days of completion of the <br /> test. <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 #115 - " Designated Underground Storage Tank Operator Identification Form " not submitted within <br /> 30 days . <br /> ❑ This violation was corrected [ I This violation will be corrected by ( date ) : <br /> ❑ Supporting documents included a <br /> Describe actions taken or will be taken to correct violation : p U k 'T !� L t2 S <br /> Cofre_ c ad <br /> Page 2of3 <br /> Rev. 8/27/2019 <br /> 1868 E . Hazelton Avenue I Stockton , California 95205 T 209 468-3420 F 209 464-0138 1 www, sjcehd. com <br />