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SAN J o A Q U I N Environmental Health Department <br /> C(..�t.,? N Y <br /> Corrective Action Statement <br /> RE: April 28, 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: PERSHING GAS FOR LESS Submit completed form to: <br /> Facility address: 4445 N PERSHING AVE SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10181565 ATTN: LYDIA BAKER <br /> PR0231785 1868 E HAZELTON AVENUE <br /> STOCKTON,CA 95205 <br /> Violation#106-Failure to submit and maintain a current facility plot plan 1 site map. <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: �CJL�;y t�(C 1 �jorj j)fZ i- v <br /> U Url)l) 1 ON CF11_ U0 1N SID "�,�.a�F/l. <br /> Violation#116-Failure to submit"Monitoring System Certification Form"within 30 days of completion of the <br /> test. <br /> Er'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: 014lio16-f 4 syji Frn (-'�I/(jjl=��71(3 y� <br /> L.-,I(_6,- CeaS nJCL� A142 / L.-,I(_ �V�S/7r MdN/1�A�r.r( �`��(-M C6fLI I�I�M Gid 1!/7E #4 <br /> rtf�d�C 'fnllNiL `14U <br /> L9/16W12020 Page 2 of 2 <br /> 868 E Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 ( www sjgov.org/EHD <br />