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5KJOAQUEnvironmental Health Department <br /> COUNTY <br /> 4L' <br /> ;'�rrrsr ,s r ws h"t, <br /> Corrective Action Statement <br /> RE: June 27, 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 <br /> form with the Return to Compliance Certification within 30 days of inspection- If you have any questions, please <br /> contact Paul Nso at(209)616-3049 or pnso@sjgov.org. <br /> Facility name: ARCO AMPM Submit completed form to: <br /> Facility address: 2056 CRESTWOOD AVE SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10542625 ATTN- PAUL NSO <br /> 1865 E HAZELTON AVENUE <br /> PRO542283 STOCKTON. CA 95205 <br /> Violation#118-Failure to submit the"Overfill Prevention Equipment Inspection Report Form"within 30 days. <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: Ory S fJT <br /> Violation#203-Failure to maintain monitoring records for 36 months and maintenance records for 60 <br /> months. <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 /> Violation#205-Failure to submit and have current UST Monitoring Plan readily accessible at the facility. <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: 2 �Z3 GERS i 'S � ly <br /> -- 2 t r--►-r=im t S �►-� s l 3 I N��2 . I r� �� l n�h <br /> PL 0-tJ5 — <br /> Page 2 of 3 <br /> Zev.911&2020 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 I F 209 464-0138 1 www.sjgov.orglEHD <br />