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II J OF V SAN F yQU I Environmental Health Department <br /> 1 4 J -- ��*+ kr�'` ICI U 1 T <br /> Corrective Action Statement <br /> RE: September 18, 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: 7-ELEVEN INC#14113 Submit completed form to: <br /> Facility address: 3040 W BENJAMIN HOLT DR SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10165777 ATTN: LYNSEY SAMMONS <br /> PR0506497 1868 E HAZE LTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#10-2030074-Annual Monitoring System Certification Form to the CUPA within 30 days of <br /> completion of the test. <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 /> Tanknology submitted test results on 10/8/24. <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 />