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Environmental Health Department <br /> SAN :: � OQ � l � N <br /> � . 0: CJt..INTY - <br /> 4:1 - . <br /> Corrective Action Statement <br /> RE : May 17 , 2022 , Underground Storage Tank inspection report <br /> For each violation listed below , indicate If the vlolation has been corrected or will be corrected by a certain date . <br /> Also , describe what was done to correct the violation in the Gpaee 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 John Alaniz at (209) 616-3053 or jalaniz1 @sigov. org . <br /> Facility name : PARKWOODS GAS & FOOD <br /> Submk completed form to ; <br /> Facility address: 1612 W HAMMER LN SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> ATTN : JOHN AI.ANIZ <br /> CERS ID : 10181241 1868 E HAZELTON JkVENUE <br /> PR0231127 STOCKTON , CA 95205 <br /> Violation #107 . Failure to submit and maintain complete and current financial responsibilit f documents . <br /> This violation was corrected ❑ This violation will be corrected by (date) ; <br /> ❑ Supporting documents included <br /> Describe actions taken or will be to correct violation ; Cis <br /> ✓ <br /> INNER <br /> Violation 9319 . Failure to comply with overfill prevention equipment requirements. <br /> This violation was corrected ❑ This violation will be corrected by (date ): <br /> p Supporting documents included ' ( Si) r-c <br /> Describe actio s taken or will be taken to correct violation : ri <br /> -,• M � EIVELj <br /> HEALTH <br /> i V VI �, Gci <br /> Page 2 of 2 <br /> Roo. ener2ozo <br /> 1868 E . Hazelton Avenue I Stockton , California 95205 1 T 209 466-3420 F 209 464 - 0138 1 www . slgov . org/EHD <br /> Received Time Jun , 1 , 2022 11134AM No , 7218 <br />