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Environmental Health Department <br /> SAN JOAOUIN <br /> Corrective Action Statement <br /> RE: May 30, 2025, inspection report by a certain date Also, <br /> For each violation listed below,indicate d the violation has been <br /> below elcll h v olation3ubmit this completed form <br /> describe what was done to correct the violation in the space p lease Contact <br /> with the Return to Compliance Certifi cation within 30 days of inspection if you have any questions,p <br /> Allen Asio at(209)616-3031 or alien asio(Dsjgov.org. <br /> Facility name: PARKWOODS GAS it,FOOD <br /> Submit completed form to: <br /> Facility address 1612 W HAMMER LN SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> ATTN ALLEN ASIO <br /> CERS ID 10181241 1868 E HAZELTON AVENUE <br /> PR0231127 STOCKTON,CA 95205 <br /> Violation e3-2010013-Facility has submitted a complete and accurate UST Monitoring Plan.. <br /> tD This violation was corrected ❑This violation will be corrected by(date): <br /> Supporting documents included 010 � �k f")IJ n <br /> Des:.-be actions taken or will be taken to correct violation: <br /> Violation ill-201 D003-Owner/Operator submitted DO form and/or informed the CUPA of any change(s) <br /> within 30 days(TCR 10). <br /> Ly This violation was corrected ❑This violation will be corrected by(date): <br /> ❑ Supporting documents included <br /> LJ <br /> Descnbe actions taken or will be taken to correct violation: <br /> Page 2 of 3 <br /> Rev.9/16/POZO <br /> 1868 E.Hazelton Avenue I Stockton,California 952051 T 209 468-34201 F 209 464-0138 1 v<^x,.v.sjgov.org/EHD <br />