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IF 11 <br /> . r <br /> SAW � a Environmental Health Department <br /> CC) UNrt Y <br /> Corrective Action Statement <br /> RE: May 24 , 2023 , Hazardous Waste Inspectlon report <br /> For each violation listed below, indicate if the violation has been corrected or will be corrected by a certain date. <br /> Also, describe what was done to correct the violation in the space provided below each violation, Submit this <br /> completed form with the Return to Compliance 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: 1330 E YOSEMITE AVE SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10184191 ATTN: STACY RIVERA <br /> PR0518218 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation #104 as No modified contingency plan. 7 , <br /> ❑ This violation was corrected 0 This violation will be corrected by (date): <br /> ❑ Supporting documents Included -{ -� <br /> Describe actions taken or will be taken to correct violation: 1 ►tee- `� ( 0 ^6 Is 20J I d <br /> -"r 'i` _)ae nt �--i,� ,�- f C G� i �t. t11 iP �► b a-c r� a✓h,J�c�� <br /> w e,, earrc cAof dam. 'S7 2 !U Z,,Q 2,9 <br /> Violation #110 - Failed to keep signed copy of manifests from the designated facility for three years. <br /> 4`1 �' <br /> ❑ This violation was corrected 12"This violation will be corrected by (date): �/ y3 <br /> ❑ Supporting documents included <br /> Describe actions taken or will be taken to correct vio at ono <br /> dlet u <br /> �2 W14 Ord <br /> O <br /> Violation #117 - Failed to submit a written response within 30 days of receiving an inspection report. ('� d <br /> ❑ This violation was corrected his violation will be corrected by (date): J 12'x'¢ l 2,0 "7, —� <br /> ❑ Supporting documents included <br /> AJ <br /> Describe actions taken or w II betaken to co act violation: M �a U <br /> We t4wflll OFF <br /> j41%ejjbCrk 42,07 <br /> D tY► 9a ereJ a U / n <br /> /?'2A O <br /> ftv, &r0M Page 2 of 3 <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-34201 F 209 464-0138 I www.sjgov.org1EHD <br />