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K. Environmental Health Department <br /> "M N <br /> SAN;� OA I <br /> Corrective Action Statement <br /> RE: February 03, 2025, 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 /> Lynsey Sammons at (209) 616-3067 or Isammons@sjgov.org. <br /> Facility name: A&A GAS & FOOD MART Submit completed form to: <br /> Facility address: 16 E HARDING WAY SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10181239 ATTN: LYNSEY SAMMONS <br /> PR0231136 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation #3 -2010013 - Facility has submitted a complete and accurate UST Monitoring Plan.. C <br /> Q/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 /> YA C't-v rd a ,I1 Vv i-v) Jotbi7w' V44- <br /> i <br /> Violation #5 -2030041 -A current facility plot plan is maintained and has been submitted. <br /> yJ <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 /> dj <br /> Violation #10 -2030074 -Annual Monitoring System Certification Form to the CUPA within 30 days of <br /> completion of the test. <br /> 7t/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 /> vd <br /> If <br /> Page 2 of 4 <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 />