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SAN <br /> J O A Q U I Environmental Health Department <br /> _.�.+�.r rsq tr�e�� rrz 54• }7 rrn <br /> Corrective Action Statement <br /> RE: June 02, 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: EXCEL PETROLEUM-HAMMER LANE Submit completed form to: <br /> Facility address: 3304 W HAMMER LN SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10184253 ATTN: LYNSEY SAMMONS <br /> PR0516354 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#53-2010007-Submitted/maintained current Cert of Financial Responsibility/mech of financial <br /> assurance(TCR 11). <br /> VThis violation was corrected ❑This violation will be corrected by(date): <br /> ❑ Supporting documents included <br /> Updated Certification of Financial Responsibility&CFO letter <br /> were uploaded to the tablet onsite, as well as onto the CERS portal. <br /> Violation#56-2030013-DO inspections completed at least every 30 days and meet all requirements(TCR <br /> 12). <br /> VThis 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: All DO reports kept electronically on the tablet have been signed <br /> by the operator(see attached) and date of secondary containment has been added to DO reports for 08/23/24, 09/20/24, & <br /> 10/18/24(see attached for proof of completion). <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 />