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SAN JOAQUIN Environmental Health Department t.; N Corrective Action Statement RE: May 23, 2022, Underground Storage Tank inspection report For each violation listed below,indicate if the violation has been corrected or will be corrected by a certain date. Also, describe what was done to correct the violation in the space provided below each violation. Submit this completed form with the Return to Compliance Certification within 30 days of Inspection. If you have any questions,please contact Paul Nso at(209)616-3049 or pnso@sjgov.org. Facility name: DBA CIRCLEK, REFUEL PETROLEUM INC. Submit completed form to: Facility address: 419 S MAIN ST SJC ENVIRONMENTAL HEALTH DEPARTMENT CERS10: 10181307 ATTN: PAUL NSO PR0231433 1868 E HAZELTON AVENUE STOCKTON,CA 95205 Violation#107-Failure to submit and maintain complete and current financial responsibility documents. (¢ This violation was corrected ❑This violation will be corrected by(date): ❑ Supporting documents included Describe actions taken or will be taken to correct violation: I iR1nAC>-zQ ET--3 e-12R4, (p-22-22 Violation#113-Failure to conduct secondary containment testing. This violation was corrected ❑This violation will be corrected by(date): ❑ Supporting documents included Describe actions taken or will be taken to correct violation: 5�li�N A�y C ON`C f\vN 1N\.0 N� s 5 4 prS +acar 5 S---2-1 gukt C L,DaS S4L�T LE 14-:- i Nns4: Pwl IN Ito Violation#115-Failure to submit"Monitoring System Certification Form"within 30 days of completion of the test. 15 This violation was corrected ❑This violation will be corrected by(date): ❑ Supporting documents included n Describe actions taken or will be taken to correct violation: l tV LE ls,;ai 0-14-1Z AS C!Er IiVIjl 11'll e 1h\ C�i'ht,.l� B AFrOKDfi, P CA-)CV t1vCW 1 N Page 2 of 4 Rev.9,162020 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s190v.or91EHD