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SAN J O A Q U N Environmental Health Department <br /> Corrective Action Statement <br /> RE: August 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 Gabriela Garcia-Mejja at(209)616-3037 or ggarcia-mejia@sjgov.org. <br /> Facility name: MANTECA GAS 8"FOOD* Submit completed form to: <br /> Facility address: 1229 E LOUISE AVE SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10186837 ATTN:GABRIELA GARCIA-MEJIA <br /> PR0527041 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#115.Failure to submit"Monitoring System Certification Form"within 30 days of completion of the <br /> test. <br /> ❑ This violation was corrected f(This violation will be corrected by(date): <br /> ❑ Supporting documents included �s <br /> Describe actions taken or will be taken to correct violation:"' <br /> A <br /> r Y-W 1 » <br /> Violation#116-Failure to submit the"Spill Container Testing Report Form"within 30 days. <br /> ❑ This violation was corrected 2�Shis violation will be corrected by(date): 1"COZ4AV <br /> ❑ Supporting documents included A <br /> Describe actions taken or will be taken to correct violation: C' LAA t Lx— .-' <br /> h ,> <br /> Page 2 of 4 <br /> Rev.9116124213 <br /> 1868 E. Hazelton Avenue I Stockton,California 95205 i T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />