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SANaIOAQUIN Environmental Health Department <br /> x H U <br /> --,COUNTY---- <br /> Corrective <br /> COUNTY- -- <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 /> SUPER STOP GAS & LIQUOR*, 290 N MAIN ST STE C, CERS ID: 10181339, PR0231438 <br /> Violation#115-Failure to submit"Monitoring System Certification Form"within 30 days of completion of the <br /> test. <br /> GY"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: f V g M I-T Uj I f 1 N 3 0 / S <br /> IN 2E <br /> Violation#116-Failure to submit the"Spill Container Testing Report Form"within 30 days. <br /> 9-"'"This violation was corrected ❑This violation will be corrected by(date): <br /> ❑ Supporting documents included L W gyet <br /> p" <br /> Describe actions taken or will be taken to correct violation: I L Z— z5Uig rni i I li Yl 30 DWS <br /> V <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 includedI <br /> Describe actions taken or will be taken to correct violation: �h)1 1 Sy 1+r11 I IQi()>n <br /> LA-9i -tai, t-U <br /> Page 3 of 5 <br /> Rev.9/1612020 <br /> 1868 E. Hazelton Avenue i Stockton,California 952051 T 209 468-3420 i F 209 464-0138 i www.sjgov.org/EHD <br /> Scanned with CamScanner <br />