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S A N J O A Q U I N Environmental Health Department <br /> Corrective Action Statement <br /> RE: February 05, 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: SHOP N GO 3 Submit completed form to: <br /> Facility address: 4511 PACIFIC AVE SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10180943 ATTN: LYNSEY SAMMONS <br /> PR0231216 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation #2 - 2010010 - Complete and accurate UST Operating Permit Application has been submitted.. <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 /> e e ua k A ls� CZ <br /> Violation #4 - 2010014 - Facility has submitted a complete and accurate UST Response Plan.. <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 /> Violation #5 - 2030041 - A current facility plot plan is maintained and has been submitted. <br /> EP 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 /> Page 2 of 6 <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 />