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F-nvironmental Health Department <br />UNTY- <br />Corrective Action tatemo11t <br />RE-. December 13, 2021: Underground Storage Sank nspeckion raPOA <br />For each violafipn listed below, indicate lithe violation has been uorreclad or will be wrrectad by a certain date- ,4150. <br />describe what was done Ip correct the viol,S n in the space pfovided below each violation. Subrnit Ih is completed <br />form with the Return to Com pliarm Certificatiorn within 30 days at inspeclion- It you have any questioris, pleaseL <br />contact Paul N% at (209) 616-3049 or pnso sjg0v,org. <br />Facility name; CITY GAS &LIQUOR Submit Completed farm to; <br />Facility address: 16470 CAMBRIDGE ST SJC ENVIRONMENTAL HEALTH UEPARTMEb1T <br />CERS 117; 10779784 ATTN: PAUL NSO <br />PRO231532 =868 E HAZELTQN AVENUE <br />STOCKTON, CA 95205 <br />vi❑lation #122 - Failure to impIomant correctiana and submit written resp0ns4� within 30 days of receIving the <br />raps rt. <br />❑ This violation was corrected OThis violation will 4e GOrractad by (date); I f <br />❑ Supporting doaurnents included j7 <br />Describes ar-tions taken or will be taken to Correct violation. <br />Violation 9208 - Failure to comply with tho designated -operator inspection requirements, <br />❑ Thls Wolation was torrc-cted QThis violation will bii� corrected by �datej= J 4 <br />❑ Supporting documents included~ x <br />Describe actions taken or will be taken to correct <br />_violation_ i `J k <br />`` <br />— C-1DrrCACA <br />�rw ctra <br />Violation #319 - Failure to comply with overfill prevention equipment requirements. <br />0 This violation was corrected C7 This violation will be corrected by (date); <br />❑ Supporting documents included <br />Describe oci ions taken or willa taken to correct violation- <br />. Di � O i -fie; .'lit' 1/15 <br />Page 2 of 2 <br />row. a++s,z)20 <br />I /I <br />We Wof <br />1866 E. Hazefton Avenue I Slockton, Celifornia 952 D5 I T 209 468-3420 j F 209464-0138 1 wNw,sjgov.org EHD <br />