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�I��a An I I I Environmental Health Department <br /> �iL COUNTY <br /> Greatness grows here, <br /> Corrective Action Statement <br /> RE: April 15, 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 pnsopsigov.orq. <br /> Facility name: QUIK STOP MARKET#3132 Submit completed form to: <br /> Facility address: 3555 W HAMMER LN SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10180893 ATTN: PAUL NSO <br /> PR0231130 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#113-Failure to submit"Monitoring System Certification Form"within 30 days of completion of the <br /> test. <br /> If+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 /> The current Monitoring System Certification and Spill Container Test has been submitted into <br /> CERS and going forward will be submitted within 30 days of completion of test. <br /> MSC from 2019 attached to RTC. <br /> Violation#121 -Failure to implement corrections and submit written response within 30 days of receiving the <br /> report. <br /> IN 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: Moving forward a written response documenting <br /> corrective actions taken or proposed will be submitted and all corrections will be implemented within 30 <br /> days of receiving the inspection report. <br /> Page 2 of 4 <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 />