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WSAN 10AQUIN Environmental Health Department <br /> pit 1 . 1 - COUNTY <br /> `wiz/rosy`%r/ Grc � tr • :: :• � ;� r .::• ., s ; rt• rc . <br /> Corrective Action Statement <br /> RE : May 19 , 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 Paul Nso at (209) 616-3049 or pnso@sjgov. org . <br /> Facility name : QUIK STOP MARKET #551121 Submit completed form to : <br /> Facility address : 1196 W LOUISE AVE SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : 10180667 ATTN : PAUL NSO <br /> PR0231430 1868 E HAZELTON AVENUE <br /> STOCKTON , CA 95205 <br /> Violation #122 - Failure to implement corrections and submit written response within 30 days of receiving the <br /> report. N/A <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 /> REMOVED FROM INSPECTION REPORT <br /> Violation #202 - Failure to retain a paper or electronic copy of the permit to operate at the facility . <br /> IN 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 /> Current Permit to Operate has been provided to site to post and submit into binder . <br /> Page 2 of 3 <br /> Rev. 9/16/2020 <br /> 1868 E . Hazelton Avenue I Stockton , California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www. sjgov. org/EHD <br />