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ICI �1 O �1 I I Environmental Health Department <br /> IY Al t� <br /> COUNTY <br /> — Greurne-ss grows her <br /> Corrective Action Statement <br /> RE: April 01, 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: QUIK STOP MARKET#132 Submit completed form to: <br /> Facility address: 3555 W HAMMER LN SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10180893 ATTN: LYNSEY SAMMONS <br /> PR0231130 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#67-2030078 -Owner/Operator retained a paper or electronic copy of the permit to operate at the <br /> facility. <br /> 13 This violation was corrected ❑This violation will be corrected by(date): <br /> E9 Supporting documents included <br /> Describe actions taken or will be taken to correct violation: <br /> The most recent PTO was sent to site and has been posted onsite. Photo atatched. <br /> Violation#71 -2030061 -Any unauthorized release from the primary containment recorded. <br /> LJ 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 /> A recordable release statement has been sent to the site to maintain with the facility's monitoringrecords. <br /> ends. <br /> The recordable release is attached. In the future required information regarding releases will be recorded <br /> and the record will be maintaned on site. <br /> Page 2 of 2 <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 />