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Q SAN 10 A U IN Environmental Health Department Corrective Action Statement RE: September 23, 2019 , Underground Storage Tank inspection report For each violation listed below, indicate if the violation has been corrected or will be corrected by a certain date. Also , describe what was done to correct the violation in the space provided below each violation . Submit this completed form with the Return to Compliance Certification within 30 days of inspection . If you have any questions , please contact Paul Nso at (209 ) 468-3432 or phso@sjgov. org . EI Dorado Food Mart, 1901 S EL DORADO ST, CERS ID, 10180839, PR0231092 Violation #118 - Failure to submit the " Underground Storage Tank Statement of Understanding and Compliance Form " . 2r This violation was corrected ❑ This violation will be corrected by ( date) : 00' Supporting documents included Describe actions taken or will be takian to correct violation : lJe LOA-AEA!5 T�O Stw- / d Violation #121 - Failure to implement corrections and submit written response within 30 days of receiving the report. W/This violation was corrected is violation will be corrected by ( date) : ❑ Supporting documents included Describe actions taken or will be taken to correct violation : W t l 0701<F on �. _..s / � ..- . A _ i � sii iii i s ti i 9 QM ;rl - TO SuBm , T 644 T/ MoL I i Violation #124 - " Overfill Prevention Equipment Inspection Report Form" not submitted within 30 days of i inspection . his violation was corrected ❑ This violation will be corrected by ( date) : ❑ Supporting documents included Describe actions taken or will be taken to correct violation : WE. W i ✓" A K@ �J�2ti 'toRz=_ To � '7' S7"- iL� S �Jc-TS 5v8w� , 7��i.d GAJ TiOEtx � MZigoc/rt//e'2 Page 3 of 6 j Rev. 812712019 1 1868 E . Hazelton Avenue ( Stockton , California 95205 T 209 468 - 3420 i F 209 464-0138 1 www, sjcehd. com ,f;