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SAN J O A Q U I N Environmental Health Department <br /> r; - COU NTY-- <br /> C;„ y Greatness gr�ow5 Frere. <br /> Corrective Action Statement <br /> RE: July 07, 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 <br /> form with the Return to Compliance Certification within 30 days of inspection. If you have any questions, please <br /> contact Paul Nso at(209)616-3049 or pnso@sjgov.org. <br /> Facility name: 7-ELEVEN INC#17647 Submit completed form to: <br /> Facility address: 1048 W YOSEMITE AVE SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10165823 ATTN: PAUL NSO <br /> PR0231462 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 /> X 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 /> Results for the 7/28/21 testing event were printed and mailed on 8/2/21 by our testing vendor, Tanknology. Reforwarding <br /> Violation#116-Failure to submit the"Spill Container Testing Report Form"within 30 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 /> Results for the 7/28/21 testing event were printed and mailed on 8/2/21 by our testing vendor,Tanknology. Reforwarding <br /> Page 2 of 3 <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 />