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SAN MOU Environmental Health Department <br /> Corrective Action Statement <br /> RE: December 27, 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 Frederick Emasl at{-M9)Bi I&,ID23 Dr Drg. <br /> ADELFO'S ARCO AMIPM, 3443 CHEROKEE RD, CERS ID: 10830655, PRO542573 <br /> Violation#118-Failure to submit the"Overfill Prevention Equipment Inspection Report Form"within 30 days. <br /> This violation was corrected E3 This violation will be corrected by(date): <br /> Supporting documents included <br /> Describe actions taken or will be taken to correct violation: 0,1 <br /> 4:;Wayu� <br /> Violation#122 -Failure to implement corrections and submit written response within 30 days of receiving the <br /> report. <br /> , his violation was corrected E3 This violation will be corrected by(date): <br /> 13 Supporting documents included <br /> Describe actions taken or will be taken to correct violation: 3 <br /> Rev.9/16/2020 Page 3 of 3 <br /> 1868 E.Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 wWw-sjgov.org1EHD <br />