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SANAOAQUIN <br /> Environmental Health Department <br /> -i Ft0 —COUNTY <br /> te r. (,reotness grpns here, <br /> Corrective Action Statement <br /> RE: February 24, 2026, inspection report <br /> For each violation listed below. indicate it the violation has been corrected or will" corrected by a certain d8t@, Also, <br /> describe what was done to correct the violation in the space provided below-each wolation_ Sut)mil this completed f*rm <br /> with the Return to Cornpliance Ceriirrcation within 30 days at inspeclion_ It you have any questions, please contact <br /> Lynsey Sanwriorts at (209)616-3067 or Jsamrnons sfgav_or9. <br /> facility name. SKELL FOOD MART Submd completed Form lo= <br /> Faculty address- 2320 N EL DORADO ST SJC ENVIRONMENTAL HEALTH 1)EPARTMENT <br /> CERS ID 10182111 ATTN: LYNSEY SAMMONS <br /> PRO231084 1068 E HA?ELTON AVENUE <br /> STOCKTON-CA 95205 <br /> Violation 42-2011009-Complete and accurate application for a permlt to operate a UST has been <br /> submitted and mairntained, <br /> 13 This violation was r orrected l3 This vlolatian will be corrected by(date}. <br /> 0 Supporting documents included <br /> Describe actions taken or wilt toe taken to potion violaUan; <br /> YiolaIion 94 -2t}11012- Facility has sub milted and maintains a monitoring Site plan, <br /> ❑ This violation was corrected ❑ This violation will t>e corrected by (date); <br /> ❑ Supporting documents included <br /> Describe actions taken or wJl be taken to correct vVzilion; <br /> Violation 95-2011013-Fac9ity has submitted a complete and accurate LIST Response Plan, <br /> ❑ This violation was corrected ❑ This violation vriII be corrected by{date); <br /> ❑ Supporting documents incluti!ed <br /> Derrribe actions taken or wail be taken to correct violation; <br /> Page 2 of 4 <br /> tfisv_9V7&law <br /> 1868 E_ Hazeltun Avenue 1 3WcMon, Califomia 952051 T 209 4 68-3420 1 F 209 454-0 1138 1 www,sigov.org/EHE) <br />