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SAN J O A Q U I N Environmental Health Department <br /> Corrective Action Statement <br /> RE: April 19, 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 Stacy Rivera at(209)616-3043 or sdvera@sjgov.org. <br /> Facility name: GREWALS GAS&LIQUOR' Submit completed form to: <br /> Facility address: 4100 E FREMONT ST SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10180875 ATTN:STACY RIVERA <br /> PR0231574 1868 E HAZELTON AVENUE <br /> STOCKTON,CA 95205 <br /> Violation#102-Failure to submit a complete and accurate application for a permit to operate a UST. <br /> LY 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: L�! �( C'c P-e 5 <br /> Violation#208-Failure to comply with the designated operator inspection requirements. <br /> ❑ This violation was corrected ❑ This violation will be corrected by(date): <br /> ❑ Supporting documents included q <br /> Describe actions taken or will be taken to correct violation: <br /> j OnJ loik r /(-e Wt�h �o Gr �/ D fir fc <br /> �J��arr work 10r��r( y rr�g an i55ve . 1 �crve lro, Gn r,pdo d <br /> Pt.,� rc l✓�A dk k C 41,„ <br /> Violation#319-Failure to comply with overfill prevention equipment requirements. <br /> Q9 This violation was corrected ❑This violation will be corrected by(date): <br /> ❑ Supporting documents Included /I__ � //� /, <br /> De ribs actions taken or will <br /> be taken to correct violation: �'7{ R ypY+� �fI/n y +/✓d S <br /> ACC Ct`r a 1244 dL <br /> c� p.r4iWvI i✓1 CtppoJ✓) // CJt-v.anL ✓I � <br /> li^^✓/'>ln �Lc�r yc �t �NG- iv-P t'Jr t`u arc I '1 t,/�ac �tar'1S' <br /> Page 2 of 2 <br /> Rev.911612020 <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />