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S A N J a AQ U [[ N Environmental Health Department <br /> Corrective Action Statement <br /> RE: April 15, 2021, Underground Storage Tank inspection report <br /> For each iola6on 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 <br /> form with he Return to Compliance Certification within 30 days of inspection. If you have any questions, please <br /> contact C rol Presto at(209)616-3061 or cpresto@sjgov.org. <br /> Facility riz me: Trinity Parkway AMPM ARCO#83819 Submit completed form to: <br /> Facility ac dress: 10715 Trinity Pkwy SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10760026 ATTN: CAROL PRESTO <br /> PR0541281 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#107 -Failure to submit and maintain complete and current financial responsibility documents. <br /> 10 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: S'v(�� �4 d <br /> G0 1C t-a �p-j al G u V-r,c n',c- ri'-, a-i c P;1 Ce Q-+-V <br /> Violation#109-Failure to submit"Designated Underground Storage Tank Operator Identification Form" <br /> within 30 days. <br /> ® his violation was corrected ❑ This violation will be corrected by (date): <br /> ❑ 1upporting documents included <br /> Des vibe actions taken or will be taken to correct violation: SU b0-1i,-+ e h,9e e d <br /> (�c.r o7 �d ar L a f c✓ d e- h,04 r <br /> Page 2 of 4 <br /> Rev.9/1612020 <br /> 18 8 E. Hazelton Avenue i Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org;EHD <br />