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Environmental Health Department <br /> SAN -JOAQUINU <br /> Corrective Action Statement <br /> RE: July 08, 2022, Underground Storage Tank inspection report <br /> For each.violation-listed below,-indicate if the-violation has been.corrected or wilt-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)-61.6 3049 or pnso@s)gov.org.- <br /> Facility name; S B GAS&MARKET Submit completed form to: <br /> Facility address. 515 W ELEVENTH ST STE 301 S,1C ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10181209 ATTN. PAUL NSO <br /> PR0231400 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 ®This violation will be corrected by(date): 7-24 <br /> tf Supporting documents included <br /> Describe actions taken or will be taken to correct violation: i rl q Z e L; .= se, T�i 7- _[i t' <br /> Violation-#11&-Failure-to submit-the-"Spill.Container-Testing.Report-Form"within-30 days- <br /> 0 This violation was corrected Rf This violation will be corrected by(date): -k/ -Z- <br /> lT Supporting documents included <br /> Describe actions taken or will be taken to correct violation: c G; , . t f_ r7�< 1?e ; r -e 7�i CY`r t�7 <br /> 4"S"" B Sc-�i 7 e? b i T e,, lj 0 Y c 7 <br /> Viotation#1.1.7-t=ailed to submit"Secondary Containment Testing.Deport Dorm"within-30 days after the-test- <br /> ❑ This violation was corrected B This violation will be corrected by(date): 7~' Z Z <br /> © Supporting documents included <br /> Describe actions taken or will be taken to correct violation: ibO LL) ; I I cT k' C' t f -r-w r z T t4 e <br /> Page 2 of 3 <br />