Laserfiche WebLink
SAN 10AQ U I N Environmental Health Department <br /> al COUNTY— <br /> itr r'° � IC' L' t11i55 J ' Ci S herej <br /> Corrective Action Statement <br /> RE : April 05 , 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 form <br /> with the Return to Compliance Certification within 30 days of inspection . If you have any questions , please contact <br /> Paul Nso at (209) 616-3049 or pnso@sjgov. org . <br /> Facility name : SUPER STOP GAS & LIQUOR* Submit completed form to : <br /> Facility address : 290 N MAIN ST STE C SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : 10181339 ATTN : PAUL NSO <br /> PR0231438 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 /> q 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 /> L 4 4 / onot -0 Lti -eeS <br /> Violation #115 - Failure to submit " Monitoring System Certification Form " within 30 days of completion of the <br /> test. <br /> 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 /> / w c LL rn �� J'�t�r � _ r m l S <br /> Page 2 of 4 <br /> Rev. 9/16/2020 <br /> 1868 E . Hazelton Avenue I Stockton , California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www. sjgov. org/EHD <br />