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COMPLIANCE INFO_2021
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2300 - Underground Storage Tank Program
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PR0231433
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COMPLIANCE INFO_2021
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Entry Properties
Last modified
8/4/2021 9:30:55 AM
Creation date
1/7/2021 11:33:13 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2021
RECORD_ID
PR0231433
PE
2361
FACILITY_ID
FA0003685
FACILITY_NAME
DBA CIRCLEK, REFUEL PETROLEUM INC.
STREET_NUMBER
419
Direction
S
STREET_NAME
MAIN
STREET_TYPE
ST
City
MANTECA
Zip
95336
APN
21938610
CURRENT_STATUS
01
SITE_LOCATION
419 S MAIN ST
P_LOCATION
04
P_DISTRICT
005
QC Status
Approved
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SJGOV\kblackwell
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EHD - Public
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SAN J Q Q Q U I N Environmental Health Department <br /> CCl? U : jTY <br /> Corrective Action Statement <br /> RE: May 27, 2020, 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: DBA CIRCLEK, REFUEL PETROLEUM INC . Submit completed form to: <br /> Facility address : 419 S MAIN ST SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS iD : 10181307 ATTN: PAUL NSO <br /> PR0231433 1868 E HAZELTON AVENUE <br /> STOCKTON , CA 95205 <br /> Violation #103 - Failure to submit and maintain complete and current financial responsibility documents . <br /> 5& 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 : <br /> UPi,rpRf-) izp Toce6W� <br /> Violation #113 - Failure to submit " Monitoring System Certification Form" within 30 days of completion of the <br /> test. <br /> V5 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 : <br /> Page 2 of 5 <br /> Rev. 8/27/2019 <br /> 1868 E . Hazelton Avenue ( Stockton , California 95205 T 209468- 34201 F 209464 -0138 1 www. sjcehd. com <br />
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