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42 <br /> S A N JOAQUIN Environmental Health Department <br /> --C_C3UNIY <br /> Greatness grows here. <br /> Corrective Action Statement <br /> RE: May 24, 2023, Hazardous Waste inspection report <br /> For each violation listed below,indicate if the violation has been Corrected or will be corrected by a certain date. <br /> Aliso.describe what was done to correct the violation in the space provided below each violation. Submit this <br /> completed form with the Return to Comptiance Certification within 30 days of inspection. If you have any questions, <br /> please contact Stacy Rivera at{209}616-3043 or srivera@sjgov.org. <br /> Facility name: A&A GAS FOOD MART Submit completed form to: <br /> Facility address; 1336 E YOSEMITE AVE SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10184191 ATTN:STACY RIVERA <br /> 1868 E HAZELTON AVENUE: <br /> PR0518218 STOCKTON.CA 95205 <br /> Violation#104-No modified contingency plan. <br /> I <br /> ❑ This violation was corrected (D This violation will be corrected by(date): <br /> +? I� <br /> ❑ Supporting documents included <br /> Describe actions taken or will be taken to correct violation: <br /> dial > <br /> �Cdf or F ? <br /> Violation 0110-Failed to keep signed copy of manifests from the designated facility for three years. <br /> 0 This violation was corrected 2 This violation will be corrected by(date): <br /> ❑ Supporting documents included <br /> Describe actions taken or will betaken to correct via ation. <br /> �e <br /> a <br /> Violation#117-Failed to submit a written responsewithin30 days of receiving an inspection report. <br /> D This violation was corrected LR This violation will be corrected by(date): <br /> D Supporting documents included <br /> 0escr be actions taken or will be taken to car ect violation: 6 <br /> Page 2 of 3 <br /> Rev.9119(2020 <br /> 1868 E.Haleltan Avenue I Stockton.California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.orglEHD <br />