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S A N 1 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 /> SHOP N GO 3, 4511 PACIFIC AVE, CERS ID: 10180943, PR0231216 <br /> Violation #13 - 2010017 - Spill bucket testing results submitted to the UPA within 30 days of testing. <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 /> one <br /> Tom- <br /> Violation #14 - 2010018 - Overfill prevention equipment inspection report form submitted to the UPA within 30 <br /> days. <br /> This violation was corrected ❑ This violation will be corrected by (date): <br /> ❑ Supporting documents included <br /> Describe actons taken o ill be taken to correct violation: <br /> � <br /> 1� A A I kA o 5L1 h Yh% 4, h ins t <br /> Violation #53 - 2010007 - Submitted/maintained current Cert of Financial Responsibility/mech of financial <br /> assurance (TCR 11). <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 rrect violation: <br /> n Y%XLLL• Wit "r <br /> 1 <br /> Page 4 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 />