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? O1, SAN 10 A Q U I N Environmental Health Department <br /> " COUNTY <br /> °J40FO r Greotness grows here . <br /> Corrective Action Statement <br /> RE : February 16 , 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 . <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 Lydia Baker at (209 ) 616-3046 or ( baker@sjgov .org . <br /> Facility name : SHOP N GO 3 Submit completed form to : <br /> Facility address : 4511 PACIFIC AVE SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : 10180943 ATTN : LYDIA BAKER <br /> PR0231216 1868 E HAZELTON AVENUE <br /> STOCKTON , CA 95205 <br /> Violation #208 - Failure to comply with the designated operator inspection requirements . <br /> 1W This violation was corrected ❑ This violation will be corrected by (date) : <br /> ❑ Supporting documents included <br /> i <br /> D cribe actions taken or will be taken to correct violation : e'/ P? 'fn6 77 A �� ec 7 !4 <br /> C �� G <br /> RECEIVED <br /> MAR 0 7 2022 <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <br /> Page 2 of 2 <br /> Rev. 9/16/2020 <br /> 1868 E . Hazelton Avenue I Stockton , California 95205 1 T 209 468-3420 I F 209 464-0138 1 www. sjgov.org/EHD <br />