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Environmental Health Department <br /> SAWMAOUIN <br /> _...:- Tis'tiP'4.a N. A 1 � - <br /> Corrective Action Statement <br /> RE: May 07, 2020, Underground Storage Tank inspection report <br /> For each violation listed below, indicate if the violation has been corrected or will be correcteba certain ovided below each violatony Submit this te. <br /> Also, describe what was done to correct the violation in the space pr <br /> leted form with the Return to Compliance Certification within 30 days of inspection. If you have any questions, <br /> com p <br /> please contact Paul Nso at(209)468-3432 or pnso@sjgov.org. <br /> Facility name: JAHANT FOOD N FUEL STOP <br /> Submit completed form to: <br /> Facility address: 24323 N HWY 99 SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> F ty ATTN: PAUL NSO <br /> CERS ID: 10181611 1868 E HAZELTON AVENUE <br /> PR0231947 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): g I�- <br /> ❑ Supporting documents included ii __G 1 VA 1 <br /> or will be taken to correct violation: - <br /> Describe actions taken _ <br /> Y)ct n(",10] <br /> ns -VS avxA Ocic <br /> Violation#115-"Designated Underground Storage Tank Operator Identification Form" not submitted within <br /> 30 days. <br /> COY This violation was corrected ❑This violation will be corrected by (date): 6 Z <br /> ❑ Supporting documents included <br /> Describe actions taken or will be taken to correct violation: LO j <br /> / <br /> (116A �Osi Cr�:Ls <br /> .4-o pm)-�A CJ�'v) <br /> Rev.8/27/2019 <br /> Page 2of3 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />