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SAN IEnvironmental Health Department <br /> Corrective Action Statement <br /> RE : September 02 , 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 . Also , <br /> describe what was done to correct the violation in the space provided below each violation . Submit this completed form <br /> with the Return to Compliance Certification within 30 days of inspection . If you have any questions, please contact <br /> Stacy Rivera at (209) 468-3440 or srivera aasigov. orq . <br /> Facility name : FOOD MART GASOLINE* Submit completed form to: <br /> Facility address : 2185 E FREMONT ST SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : 10181081 ATTN : STACY RIVERA <br /> PR0231118 1868 E HAZELTON AVENUE <br /> STOCKTON , CA 95205 <br /> Violation #124 = "Overfill Prevention Equipment Inspection Report Form" not submitted within 30 days of <br /> inspection. <br /> \,E2( 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 #209 = Failure to conduct the designated UST operator visual inspection at least once every 30 <br /> days. <br /> This violation was corrected ❑ This violation will be corrected by (date) : <br /> ❑ Supporting documents included <br /> Describe actions <br /> tataken 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 />