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AJOAOUIN Environmental Health Department <br />Corrective Action Statement <br />RE: August 12, 2021, Underground Storage Tank inspection report <br />For each violation its#ed 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: MANTECA GAS &FOOD` <br />Submit completed form to: <br />Facility address: 1229 E LOUISE AVE SJC ENVIRONMENTAL HEALTH DEPARTMENT <br />'ERS ID:10186837 ATTN: PAUL NSO <br />PR0527041 1868 E HAZELTON AVENUE <br />STOCKTON, CA 95205 <br />Vtolatlon #122 - Failure to implement corrections and submit written response within 30 days of receiving the <br />report. <br />'�` This violation was corrected <br />A supporting documents included <br />Describe actions taken or will be taken to <br />This viotation wilt be corrected by (date): <br />violation: <br />Page 2 of 2 <br />Rev. 9/16!2020 <br />1865 E, i-lazeitns� t\venue ; Starktar�, Gaiifomia 95?.05 i T 2.09 468-3420 i F 209 464-0138 � www.sJgov,org/EHO <br />