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O <br /> Rid <br /> Environmental Health Department JOAQUIN <br /> Corrective Action Statement <br /> RE : January 13 , 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 : VAN DE POL ENTERPRISES INC Submit completed form to: <br /> Facility address : 816 E FRONTAGE RD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : 10181513 ATTN : PAUL NSO <br /> PR0231470 1868 E HAZELTON AVENUE <br /> STOCKTON , CA 95205 <br /> Violation #103 - Failure to submit and maintain complete and current financial responsibility documents . <br /> J" 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 : <br /> r1 &e64 r <br /> Violation #105 - Failed to have an approved UST monitoring plan . <br /> This violation was corrected ❑ This violation will be corrected by ( date ) : <br /> ❑ Supporting documents included <br /> Describe actions taken or will betaken to correct violation : <br /> Violation #121 - Failure to implement corrections and submit written response within 30 days of receiving the <br /> repo/T 'his <br /> 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 /> Page 2 of 3 <br /> Rev, 8/27/2019 <br /> 1868 E . Hazelton Avenue Stockton , California 95205 1 T 209 468 - 3420 F 209 464 - 0138 1 www. sjcehd . com <br />