Laserfiche WebLink
SKJOAQUIN Environmental Health Department <br />.� . <br />—COU NTY- <br />_r4.;•. Greatness grows here. <br />Corrective Action Statement <br />RE: April 07, 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: GREWALS GAS & LIQUOR* Submit completed form to: <br />Facility address: 4100 E FREMONT ST SJC ENVIRONMENTAL HEALTH DEPARTMENT <br />CERS ID: 10180875 ATTN: PAUL NSO <br />PR0231574 1868 E HAZELTON AVENUE <br />STOCKTON, CA 95205 <br />Violation #102 - Failure to submit a complete and accurate application for a permit to operate a UST. <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 #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 />Page 2 of 3 <br />Rev. 9/16/2020 <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 />