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S A J 0 A 0 U I #N Environmental Health Department <br /> Corrective Action Statement <br /> RE: December 20, 2023, Underground Storage Tank inspection report <br /> For each violation fisted below, indicate J 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 Carol Presto at (209)616-3061 or cpresto@sjgov.org. <br /> Facility name: ADELFO'S ARCO AMlPM Submit completed form to: <br /> Facility address: 3443 CHEROKEE RD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10830655 ATTN: CAROL PRESTO <br /> PRO542573 1868 E HAZELTON AVENUE <br /> STOC:KTON. CA 95205 <br /> Violation#101 -Failure to obtain a permit to operate from the EHD including but not limited to unpaid permit <br /> fees. <br /> e 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 /> i 6 r" <br /> Violation#115-Failure to submit"Monitoring System Certification form"within 30 days of completion of the <br /> test.,/P� � <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 /> r � <br /> { 4{ <br /> Page 2 of 3 <br /> spat.gris.zozo <br /> 1868 E. Hazelton.Avem4e j Stockton, California 952051 T 209 468-3420 1 F 209 4644)138 1 ,vww.sjgov.org/EH0 <br />