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SAN 1 U A Q U I N Environmental Health Department <br /> �. L,1I ; ;., T \,` . <br /> Corrective Action Statement <br /> RE : March 09 , 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 : CAGASOLINE EXPRESS Submit completed form to : <br /> Facility address : 2115 W YOSEMITE AVE SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : 10186687 ATTN: PAUL NSO <br /> PR0526335 1868 E HAZELTON AVENUE <br /> STOCKTON , CA 95205 <br /> Violation #104 - Failure to have an approved UST Monitoring Plan . <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 /> j�la0 U �d�� < <br /> Violation #107 - Failure to submit and maintain complete and current financial responsibility documents . <br /> -'This violation was corrected. 11This violation will be corrected by ( date ) . <br /> ❑ Supporting documents included <br /> Describe actions aken or will be taken to correct violation : <br /> VL 04 <br /> Violation #109 - Failure to submit " Designated Underground Storage Tank Operator Identification Form " <br /> within 30 days . <br /> —4 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 /> j Nev. W IW2020 <br /> 1868 E . Hazelton Avenue Stockton , California 95205 T 209 468-3420 i F 209 464 -0138 1 www . sjgov . org/EHD <br /> I <br />