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il SO <br /> Environmental Health Department <br /> 00 <br /> LMd <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 /> A&A GAS FOOD MART, 1330 E YOSEMITE AVE, CERS ID : 10184191 , PR0515864 <br /> Violation #118 - Failure to submit the "Overfill Prevention Equipment Inspection Report Form" within 30 <br /> days. / <br /> [3" This violation was corrected El This violation will be corrected by (date) : <br /> E3 Supporting documents Included <br /> Describe actions taken or will be taken to correct violation: <br /> 21 40e <br /> ♦ r F <br /> /,v+ or.� �, � 3 � /» �► s9'7� -tee- <br /> Violation #122 - Failure to Implement corrections and submit written response within 30 days of receiving <br /> the report. <br /> his violation was corrected C3 This violation will be corrected by (date): <br /> M Supporting documents Included <br /> Describe actions taken or will be taken to correct Violation: <br /> M /�. /�G- C pll�e 7t9 t'e*sit74044ol 4of C or 73(ow <br /> i/'w�f� ice• 4 /D /1 �/ I�1'ZiG 75 -'`l + j'Ilri �Y1Awdo? <br /> Violation #203 - Failure to maintain monitoring records for 36 months and maintenance records for 60 <br /> months. , <br /> Ej*'*�Thls violation was corrected 0 This violation will be corrected by (date): <br /> p Supporting documents Included <br /> Describe actions taken or will be taken to correct violation: <br /> ,4 070C� <br /> Page 4 of 6 <br /> Rw. 9ti8t2020 <br /> 1868 E . Hazelton Avenue i Stockton , California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />