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Environmental Health Department <br /> SANJOAQUIN <br /> In <br /> COU NTY <br /> Greatness grows here. <br /> Corrective Action Statement <br /> RE: November 15, 2019, 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. Also, <br /> describe what was done to correct the violation in the space provided below each violation. Submit this completed <br /> form with the Return to Compliance Certification within 30 days of inspection. If you have any questions, please <br /> contact Paul Nso at (209)468-3432 or pnso@sjgov.org. <br /> Facility name: KISHIDA, GEORGE INC Submit completed form to: <br /> Facility address: 1725 ACKERMAN DR SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10181383 ATTN: PAUL NSO <br /> PR0231309 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#103 - Failure to submit and maintain complete and current financial responsibility documents. <br /> ❑ 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 /> 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 be taken to correct violation: <br /> Violation#124- "Overfill Prevention Equipment Inspection Report Form" not submitted within 30 days of <br /> inspection. <br /> ❑ 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 /> 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 />