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SAN J 0 A Q U I N Environmental Health Department <br /> Grearaess 9rowf. Jere. <br /> Corrective Action Statement <br /> RE: May 16, 2024, 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 form <br /> with the Return to Compliance Certification within 30 days of inspection. If you have any questions, please contact <br /> Matthew Won at(209)616-3029 or mwon@sjgov.org. <br /> Facility name: QUIK STOP MARKET#551121 Submit completed form to: <br /> Facility address: 1196 W LOUISE AVE SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10180667 ATTN: MATTHEW WON <br /> PR0231430 1868 E HAZE LTO N AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#3-2010013-Facility has submitted a complete and accurate UST Monitoring Plan.. <br /> Cf 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: <br /> CERS has been updated with correct model number. <br /> Violation#56-2030013-DO inspections completed at least every 30 days and meet all requirements(TCR <br /> 12). <br /> ® 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: <br /> In the future the Designated Operator will ensure that all required information is included on the DO visual <br /> inspection report. <br /> Violation#69-2030033-A current UST monitoring plan has been submitted and is readily accessible at the <br /> facility. <br /> E5 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: <br /> The uj2dated UST monitoring site 121an was submitted in CERS has been sent to site to have available for <br /> review. <br /> Page 2 of 3 <br /> Rev.9/16/2020 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />