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DocuSign Envelope ID:D0038A1B-747F-4BA9-AADD-D2307E27081C Received by EHD via email <br /> 5/17/2023 <br /> SAN )OAQU 'N' Environmental Health Department <br /> Corrective Action Statement <br /> RE: December 12, 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 Carol Presto at(209)616-3061 or cpresto@sjgov.org. <br /> Facility name: NORTH POLE GAS&FOOD INC Submit completed form to: <br /> Facility address: 574 W GRANT LINE RD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10181065 ATTN: CAROL PRESTO <br /> PR0231405 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#107-Failure to submit and maintain complete and current financial responsibility documents. <br /> Cid 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: CERS was submitted with current Financial Responsibility <br /> documents. <br /> Violation#122-Failure to implement corrections and submit written response within 30 days of receiving the <br /> report. <br /> 0 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: I will submit written responses going forward within 30 days <br /> of receiving reports. <br /> Page 2 of 2 <br /> Rev.9/16/2020 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />