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J AN JO A n U N Environmental Health Department <br />i.. <:l� fY <br />'1 i <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. <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 Kristina Saetern at (209) 616-3045 or ksaetern@sjgov.org. <br />Facility name: MY MINI MART <br />Submit completed form to: <br />Facility address: 1756 N WILSON WAY SJC <br />HEALTH DEPARTMENT <br />'ERS ID: 10180819 ATTN: KRISTINA SAETERN <br />PR0231300 1868 E HAZELTON AVENUE <br />STOCKTON, CA 95205 <br />Violation #107 - Failure to submit and maintain complete and current financial responsibility documents. <br />�� ❑ This violation was corrected <br />❑ Support <br />ing documents included <br />❑ This violation will be corrected by (date): <br />Describe actions taken or will be taken to correct violation: <br />Violation #206 -Failure to submit and have a current UST Response Plan readily available on site. <br />El This <br />violation was corrected ❑This violation will be corrected by (date): <br />Describe actions taken or will be taken to correct violation: <br />❑ Supporting documents included <br />13 This <br />Violation #208 -Failure to comply with the designated operator inspection requirements. <br />lThis violation was corrected <br />11 <br />Rev. 9/16/2020 <br />,., <br />This violation will be corrected by (date): <br />❑ Supporting documents included <br />Describe actions taken or will be taken to correct violation: <br />Page 2 of 2 <br />1868 E. Hazelton Avenue � Stockton, California 95205 � T 209 46II-3420 � F 209 464-0138 � www.sjgov.org/E11D <br />