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SAN J O A Q U f N Environmental Health Department <br /> COUNTY <br /> GrEcsrness gro►�s h,,r, <br /> Corrective Action Statement <br /> RE: April 03, 2024, 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 Matthew Won at(209)616-3029 or MWON@SJGOV.ORG. <br /> Facility name: SUPER STOP GAS&LIQUOR" Submit completed form to: <br /> Facility address: 290 N MAIN ST STE C SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10181339 ATTN:MATTHEW WON <br /> PR0231438 1868 E HAZELTON AVENUE <br /> STOCKTON,CA 95205 <br /> Violation#102-Failure to submit a complete and accurate application for a permit to operate a UST. <br /> U 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: CORQe - --e of O N <br /> Violation#104-Failure to submit a complete and accurate UST Monitoring Plan. <br /> IS( 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: C- a p-,e- - o rV 4 - S a c 4 <br /> _ -5ub-m4cat 12 It-so re-wc _ Y- s- 2L4 <br /> Violation#107-Failure to submit and maintain complete and current financial responsibility documents. <br /> P9 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: _ y - O <br /> �e t.Je-Zr e� 5U �rS <br /> — 2 <br /> Page 2 of 5 <br /> Rev.9116!2020 <br /> 1868 E. Hazelton Avenue 1 Stockton,California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br /> Scanned with CamScanner <br />