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Env0. ironmental Health Department <br /> 4IF F. IFF F,Fr IF IF <br /> . <br /> ASN <br /> 1T 44 <br /> Y <br /> 04 <br /> '; ►' tnt �rxsIF I IF <br /> raawx #>Irg <br /> Corrective Action Statement <br /> RE : November 03, 2021 , 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. Also, <br /> describe what was done to correct the violation In the space provided below each violation. Submit this completed form <br /> with the Return to Compliance Certification within 30 days of inspection. If you have any questions, please contact <br /> Shewit Woldearegay at (209) 616-3063 or stwoldearegay@sjgov.org. <br /> Facility name: A&A GAS FOOD MART Submit completed form to. <br /> Facility address: 1330 E YOSEMITE AVE SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : 10184191 ATTN : SHEWIT WOLDEAREGAY <br /> PRO515864 1868 E HAZELTON AVENUE <br /> STOCKTON , CA 95205 <br /> Violation #102 - Failure to submit a complete and accurate application for a permit to operate a UST. <br /> 13 This violation was corrected 1211001rhis violation will be corrected by (date) : <br /> 0 Supporting documents included <br /> Describe actions taken o will be taken to corre violation : <br /> i ,y6 <br /> dW CA <br /> Violation #104 - Failure to have an approved UST Monitoring Plan. <br /> O This violation was corrected 12 is violation will be corrected by (date) : <br /> O Supporting documents included <br /> Describe actions taken or l b�kent�ect violatio <br /> G <br /> Far <br /> Violation #106 - Failure to submit and maintain a current facility plot plan / site map. <br /> p This violation was corrected ❑ This violation will be corrected by (date): IL1211n <br /> O Supporting documents Included . <br /> Describe actions taken or will be taken to correct violation: Q <br /> An fqjoplieo�, <br /> Zol <br /> yJM _ l�r a nIF <br /> aay. ennnusu Page 2 of 6 <br /> If <br /> 1888 E . Hazelton Avenue 1 Stockton , Califomia 952051 T 209 488-3420 1 F 209 484-0138 I www.sjgov.org/EHD <br />