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SAN 1 O AQ U I N Environmental Health Department <br /> COLJ NTY <br /> Corrective Action Statement <br /> RE : September 16 , 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) 468-3432 or pnso@sjgov. org . <br /> Facility name : A TEICHERT & SON INC" Submit completed form to : <br /> Facility address : 120 FRANK WEST CIR SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : 10184157 ATTN : PAUL NSO <br /> PR0515365 1868 E HAZELTON AVENUE <br /> 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) : <br /> ❑ Supporting documents included <br /> Describe actions taken or will be taken to correct violation : GC� <br /> vf,.,41!;r) 6nss , 6 , .14Lv bacbw <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 wil ( be taken to correct violation : h X1 (7 U LD ai 119 n � <br /> Emirwertht, P t � <br /> L If � (� <br /> Mi <br /> iml <br /> Page 2 of 3 <br /> Rev, 8/27/2019 <br /> 1868 E . Hazelton Avenue I Stockton , California 95205 1 T 209 468-3420 F 209 464 -0138 1 www . sjcehd . com <br />