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SA NJ OAQ U I N Environmental Health Department <br /> COUNTY <br /> ,Y' C <br /> Greatness gross <br /> Corrective Action Statement <br /> RE:April 10,2023, 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 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)616-3049 or pnso@sjgov.org. <br /> Facility name: JACKSONS ENERGY#6822 Submit completed form to: <br /> Facility address: 2132 MARIPOSA RD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10180759 ATTN:PAUL NSO <br /> PRO231669 1868 E HAZELTON AVENUE <br /> STOCKTON,CA 95205 <br /> Violation#107-Failure to submit and maintain complete and current financial responsibility documents. <br /> 0 This violation was corrected 0 This violation will be corrected by(date): <br /> CY Supporting documents included 1 <br /> Describe actions taken or will be taken to correct violation: Ale-w GC 0 �4 k�Q� L rQ0'V A. <br /> Violation#203-Failure to maintain monitoring records for 36 months and maintenance records for 60 <br /> months. <br /> This violation was corrected E3 This violation will be corrected by(date): <br /> Ill'Supporting documents included <br /> Describe actions taken or will be taken to correct violation: <br /> Page 2 of 2 <br /> Rev.9116/2020 <br /> 1868 E.Hazelton Avenue 1 Stockton,California 952051 T 209 468-34201 F 209 464-0138 1 www.sjgov.org/EHD <br />