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SAN,JOAQUIN <br />Environmental Health Department <br />, 1Y <br />Corrective Action Statement <br />RE: January 25, 2021, 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: 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 #107 - Failure to submit and maintain complete and current financial responsibility documents. <br />6Y"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: CC70-S jeuts " 1(f gVbM, r , 04A <br />�inf y i rY�/1 � S, 0,,YQ 0"t k i f U1 Y3CAP�, <br />Violation #118 - Failure to submit the "Overfill Prevention Equipment Inspection Report Form" within 30 days, <br />Rr'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: Ije- ntK4 0-fe uA1 A QS2�p . <br />/nI _ fWba, - ik-4 ab untie-nks ov\ c,� b, t -,r if nd I Au,- 1A z1ve A a I K&d <br />1J4�� � 1 t� I O�ii �Ubrr► irihl,� C. <br />Violation #122 - Failure to implement corrections and submit written response within 30 days of receiving the <br />report. <br />G?" -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:71Wfe w&r, rte, R ,er nr Q_jk ajge.* <br />d�ri d JJDh s irn.r_ - A l u po (b axti civ rr�S axe- rw aLPA .-j�ja, vL <br />Rev. 9/1612020 Page 2 of 4 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />