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r <br /> i, <br /> ' Environmental Health Department <br /> ,q SAN JOAQUIN �\ , <br /> !F CC) UNITY <br /> ��F • II <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 /> DINO MART, 1001 E YOSEMITE AVE , CERS ID : 10180593 , PR0231876 <br /> Violation #110 - Failure to submit the " Underground Storage Tank Statement of Understanding and <br /> Compliance Form". <br /> ❑ This violation was corrected Q This violation will be corrected by (date) : <br /> ❑ Supporting documents included <br /> Describe actions taken or will be taken to correct violation : <br /> > <br /> Violation #112 - Failure to have properly qualified service technician test leak detection equipment every 12 <br /> months . <br /> 171 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 /> 1�V1 <br /> Violation #115 - Failure to submit " Monitoring System Certification Form" within 30 days of completion of the <br /> test. <br /> 6 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 3 of 5 <br /> Rev. 9/16/2020 <br /> 1868 E . Hazelton Avenue I Stockton , California 952051 T 209 468-3420 1 F 209 464-0138 1 www. sjgov.org/EHD <br />