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SAN JOAQUI N Environmental Health Department <br /> COUNTY <br /> Corrective Action Statement <br /> RE: March 22, 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: AGS FUEL INC DBA CIRCLE K CHEVRON Submit completed form to: <br /> Facility address: 1490 S MAIN ST SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10785304 ATTN: MATTHEW WON <br /> PR0541436 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation #109 -Failure to summit"Designated Underground Storage Tank Operator Identification Form" <br /> within 30 days. <br /> ❑ This violation was corrected This violation will be corrected by(date): Z <br /> ❑ Supporting documents included <br /> I <br /> Describe actions taken or will be taken to correct violation: <br /> rIlAn <br /> Violation #122 -Failure to implement corrections and submit written response within 30 days of receiving the <br /> report. <br /> ❑ This violation was corrected $CThls violation will be corrected by(date): z <br /> ❑ Supporting documents included _ <br /> Describe actions taken or will be taken to correct violation: 14j/, <br /> � <br /> 14(AAol 011, <br /> Page 2 of 3 <br /> Rev.911612020 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sjgov org1EHD <br />