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r. <br /> � , S A NtJ OAn U I A � �2 Environmental Health Department <br /> aWO; ► ���. � _— COUNTYAIFX <br /> -- '— <br /> Greatness brews hr. , <br /> Corrective Action Statement <br /> RE : April 26 , 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 . 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) 616-3049 or pnso@sjgov. org . <br /> Facility name : DINO MART Submit completed form to: <br /> Facility address : 1001 E YOSEMITE AVE SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : 10180593 ATTN : PAUL NSO <br /> PR0231876 1868 E HAZELTON AVENUE <br /> STOCKTON , CA 95205 <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 /> Describe actions taken or will be taken to correct violation : <br /> Violation #109 - Failure to submit " Designated Underground Storage Tank Operator Identification Form" <br /> within 30 days . <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 <br /> 5 <br /> Rev. 9/16/2020 <br /> 1868 E . Hazelton Avenue I Stockton , California 952051 T 209 468111,3420 1 F 209 464-0138 1 www, sjgov. org/EHD <br />