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I <br /> SAN 10 A Q U I N Environmental Health Department <br /> � . <br /> CSI 1 ; t' rt' , <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 /> SUPER STOP GAS & LIQUOR* , 290 N MAIN ST STE C , CERS ID : 10181339 , PR0231438 <br /> Violation #116 - Failure to submit the "Spill Container Testing Report Form " within 30 days . <br /> 6 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 /> Soh rn ed �� �/ •i k 2c <br /> Violation #117 - Failed to submit "Secondary Containment Testing Report Form " within 30 days after the test. <br /> I� 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 /> LW <br /> EMMONS <br /> Violation # 118 - Failure to submit the " Overfill Prevention Equipment Inspection Report Form" within 30 <br /> days . <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 /> Page 3 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 />