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ft Environmental Health Department <br /> 4 4 <br /> 1, j k . . <br /> Corrective Action Statement <br /> RE : June 28 , 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 Paul Nso at (209 ) 616-3049 or pnso@sjgov. org . <br /> Mossdale Chevron , 444 W MOSSDALE RD, CERS ID : 10180551 , PR0231692 <br /> Violation #208 - Failure to comply with the designated operator inspection requirements. <br /> Ery~ This violation was corrected ❑ This violation will be corrected by (date) : <br /> 0 Supporting documents Included <br /> Describe actions taken or will be taken to correct violation : MiS_S / rte &714 Pe 07��t� cr�:7 rY sn j `5 <br /> 67 ' 2 Cis- G1 1�-�iaV/d�LLI� ^CO0" �` B,f �-iir v� �e4 1ttit� Ccs 5�?�.0 reef <br /> s po i� -P /S y >3 • z ������ ��s.� ,-.-tom c3i•� � � z'> / z � Z. 1 <br /> Page 3 of 3 <br /> Rev. 9/1612020 <br /> 1868 E . Hazelton Avenue i Stockton , California 95205 1 T 209 46&3420 i F 209 464-0138 1 www. sjgov. org/EHD <br />