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SAN - JOAQUIN Environmental Health Department <br /> 011 �fTY . <br /> Corrective Action Statement <br /> RE : January 14 , 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@sigov. orq , <br /> 76 EXPRESS TIGER NO It 5777 S FRENCH CAMP RD , CERS ID : 10182157 , PRO505746 <br /> Violation #121 - Failure to implement corrections and submit written response within 30 days of receiving the <br /> report. <br /> This violation was corrected ❑ This violation will be corrected by (date) : <br /> ❑ Supporting documents included <br /> Describe actiQn5 taken or will bp taken to correct violation : <br /> O •- <br /> (p U d <br /> Violation #124 - "Overfill Prevention Equipment Inspection Report Form " not submitted within 30 days of <br /> inspection . <br /> E3'' This violation was corrected ElThis violation will be corrected by ( datej : <br /> ❑ Supporting documents included <br /> Describe actions taken or will be taken to correct violation: <br /> 0 for <br /> Violation #201 - Failure to maintain monitoring , maintenance , and follow up action records . <br /> n This violation was corrected ElThis violation will be corrected by (date) : <br /> ❑ Supporting documents included X <br /> Describe actions taken or will be taken to correct violation : 1C6r <br /> a a 224, -" <br /> Page 3 of 4 <br /> Rev. 8/27/2019 <br /> 1868 E . Hazelton Avenue Stockton , California 952051 T 209 468-34201 F 209 464-0138 1 mmiv. sjcehd. com <br /> i <br /> I <br /> I <br /> i <br />