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i <br /> 1RECEIVED <br /> 0V 14 2019 <br /> IS <br /> AN U A Q U N ENVIRONMENTA Environmental Health Department <br /> HEALTH <br /> C C) t i NI T Y DEPARTMENT <br /> Corrective Action Statement <br /> RE: October 17, 2019 , 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) 468111,3432 or pnso@sjgov . org . <br /> Facility name : ARCO AM PM #82602' Submit completed form to: <br /> Facility address : 2430 JOE POMBO PKWY SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : 10182265 ATTN: PAUL NSO <br /> 1868 E HAZELTON AVENUE <br /> PRO506796 STOCKTON , CA 95205 <br /> Violation #103 - Failure to submit and maintain complete and current financial responsibility documents . <br /> Id 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 : f'%�e\ a Ocl <d <br /> NINE <br /> Violation #118 - Failure to submit the " Underground Storage Tank Statement of Understanding and <br /> Compliance Form" . <br /> d 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 : S tu 6jw C- <br /> Lt S'T .Siotg Jei.., , , �— a <br /> NINE <br /> WIN <br /> Page 2 of 3 <br /> Rev, 8127/2019 <br /> 1868 E . Hazelton Avenue Stockton , California 95205 1 T 209 468-3420 1 F 2.09 464-0138 1 www . sjcehd. com <br />