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SAN J O A Q U I N Environmental Health Department <br /> Corrective Action Statement <br /> RE: March 16, 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. Also, <br /> describe what was done to correct the violation in the space provided below each violation. Submit this completed <br /> form with the Return to Compliance Certification within 30 days of inspection. If you have any questions,please <br /> contact Carol Presto at(209)616-3061 or cpresto@sjgov.org. <br /> Facility name: PLAZA LIQUOR#1 Submit completed form to: <br /> Facility address. 800 5 CHEROKEE LN SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10181667 ATTN: CAROL PRESTO <br /> PR0231325 1868 E HAZELTON AVENUE <br /> STOCKTON,CA 95205 <br /> Violation#115-Failure to submit"Monitoring System Certification Form"within 30 days of completion of the <br /> test. <br /> I" This violation was corrected ❑This violation will be corrected by(date): <br /> 13 Supporting documents included <br /> Describe actions taken or will be taken to correct violation- CLO <br /> C'L �� Q� �Ctnk <br /> z.LzS Ls�11�— UIV\. VIOL �__ 4- L rf Cit �- Vv1Q e y� <br /> {} 1 <br /> Page 2 of 2 <br /> Roy,811&2020 <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 J F 209 464-0138 1 www sjgov.org(EHD <br />