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�I �� a An I I I Environmental Health Department <br />�iL COUNTY <br />Greotness grows here, <br />Corrective Action Statement <br />RE: March 26, 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 pnsopsigov.orq. <br />Facility name: CALIFORNIA STOP' Submit completed form to: <br />Facility address: 2224 MANTHEY RD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br />CERS ID: 10181299 ATTN: PAUL NSO <br />PR0232555 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 #121 - Failure to implement corrections and submit written response within 30 days of receiving the <br />report. <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 />Page 2 of 2 <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 />