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S A N 10 A Q U I N Environmental Health Department <br /> Corrective Action Statement <br /> RE: June 11, 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 /> Allen Asio at(209)616-3031 or allen.asio@sjgov.org. <br /> Facility name: EXPRESS FUEL&MART Submit completed form to: <br /> Facility address: 701 E DR MARTIN LUTHER KING JR BLVD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10180955 ATTN:ALLEN ASIO <br /> PR0231059 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#7-2010003-Owner/Operator submitted DO form and/or informed the CUPA of any change(s) <br /> within 30 days(TCR 10). <br /> 4 This violation was corrected ❑This violation will be corrected by(date): <br /> ❑ Supporting documents included 1 <br /> Describe actions taken or will be taken to correct violation: We hA V2 <br /> V`��1� � ��-2. �lb�il�i'C'�,.li�y�. j�2.11�11�'✓I� ��2 C�2SI' YIa�P/ �I'�'��t�Jf. <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 �1 <br /> Describe actions taken or will be taken to correct violation: A �ei I- r,2 Pvr� f� h 1�b Yyti 1l-r 1. <br /> Pleafe see Ike u4tc>ej r46W. L kkg atca_b.,egt, &dapj �o .�Lo <br /> Page 2 of 4 <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 />