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SKJOAQUIN Environmental Health Department <br />.� . <br />' +x•11' <br />—COU T Y <br />Greatness grows here. <br />Corrective Action Statement <br />RE: May 06, 2020, Underground Storage Tank inspection report <br />For each violation listed below, indicate if the violation has been corrected or will be corrected by a certain date. <br />Also, describe what was done to correct the violation in the space provided below each violation. Submit this <br />completed form with the Return to Compliance Certification within 30 days of inspection. If you have any questions, <br />please contact Paul Nso at (209) 468-3432 or pnso@sjgov.org. <br />Facility name: QUIK STOP MARKET #2120* Submit completed form to: <br />Facility address: 9321 N THORNTON RD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br />CERS ID: 10181013 ATTN: PAUL NSO <br />PR0231261 1868 E HAZELTON AVENUE <br />STOCKTON, CA 95205 <br />Violation #103 - Failure to submit and maintain complete and current financial responsibility documents. <br />M 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 />Financial responsibility documents have been provided to site. <br />Violation #121 - Failure to implement corrections and submit written response within 30 days of receiving the <br />report. <br />CS 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 />For future reports a written response documenting corrective actions taken or proposed will be submitted <br />and all corrections will be implemented within 30 days of the inspection report. <br />Violation #201 - Failure to maintain monitoring, maintenance, and follow up action records. <br />Cf 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 />Overfill prevention test for 9/26/2018 and the Monitoring System Certification from 5/02/2019 has been <br />provided to site and is attached. <br />Page 2 of 3 <br />Rev. 8/27/2019 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />