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SAN JOAQUIN Environmental Health Department <br /> Corrective Action Statement <br /> RE: November 10, 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. <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 John Alaniz at(209)616-3053 or jalanizl @sjgov.org. <br /> Facility name: GRIN INVESTMENTS INC DBA:ARCO AM/PM Submit completed form to: <br /> Facility address: 6009 N EL DORADO ST SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10776040 ATTN:JOHN ALANIZ <br /> PR0542116 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#107-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: <br /> —[7'Vj-0S:c Do w m Ns HAS KkEe-iJ go-f M 17Tt�D O u CL--F-S <br /> Violation#122-Failure to implement corrections and submit written response within 30 days of receiving the <br /> report. <br /> ❑ This violation was corrected 19This violation will be corrected by(date): 2-1 <br /> ❑ Supporting documents included <br /> Describe actions taken or will be taken to correct violation: <br /> We 4.)1L-L- MAIC Su p T"'.-1 THIS \11L) LA>1tu W► u- <br /> ��f H A ' Nc F u-(vY2—- <br /> Rev.9/16/2020 Page 2 of 4 <br /> 1868 E. Hazelton Avenue( Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />