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SAN'JOAQUIN Environmental Health Department <br />---COUNTY- <br />. <br />Corrective Action Statement <br />RE: January 13, 2022, 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 />Facility name: DOES TRAVEL PLAZA Submit completed form to: <br />Facility address: 15600 S HARLAN RD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br />CERS ID: 10180541 ATTN: PAUL NSO <br />PR0231585 1868 E HAZELTON AVENUE <br />STOCKTON, CA 95205 <br />Violation #109 - Failure to submit "Designated Underground Storage Tank Operator Identification Form" <br />within 30 days. <br />Wo"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 />16A -W tlA wcm Go ut., P- �-I- - P - <br />NPA ���' 11 <br />Page 2 of 2 <br />Rev. 9116!2020 <br />1868 E. Hazelton Avenue j Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.sjgov.org/EHD <br />