Laserfiche WebLink
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 />