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SHAUN Environmental Health Department <br /> C0UNTY <br /> r55 Urflws horf' _ <br /> Corrective Action Statement <br /> RE : December 16 , 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) 616-3049 or pnso@sjgov. org . <br /> Facility name : fast and easy mart # 103 Submit completed form to: <br /> Facility address : 8660 LOWER SACRAMENTO RD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : 10181351 ATTN: PAUL NSO <br /> PR0231161 1868 E HAZELTON AVENUE <br /> STOCKTON , CA 95205 <br /> Violation #106 - Failure to submit and maintain a current facility plot plan / site map . <br /> I' This violation was corrected ❑ This violation will be corrected by (date) : <br /> /❑ Supporting documents included <br /> D scrib actions taken or <br /> will be taken to correct violation : <br /> Violation #107 - 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 /> Des ribe actions taken or will be taken to correct violation : <br /> bp� n d 0Y\ celyT a j . <br /> Violation #110 - Failure to submit the " Underground Storage Tank Statement of Understanding and <br /> Compliance Form " . <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 /> Ah Flo civ\ C ems <br /> Page 2 of 5 <br /> Rev, 9/16/2020 <br /> 1868 E . Hazelton Avenue Stockton , California 95205 T 209 468-3420 1 F 209 464-0138 1 www. sjgov . org /EHD <br />