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jr -v <br />Q � 0 � 1 <br />environmental Health Department <br />t:t -- COUNTY <br />Corrective Action Statement <br />RE: October 27, 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: QUICKI KLEEN CAR WASH <br />Submit completed form to: <br />Facility address: 707 E YOSEMITE AVE SJC ENVIRONMENTAL HEALTH DEPARTMENT <br />'ERS ID: 10182307 ATTN: PAUL NSO <br />PR0505151 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 />i <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: biJt�) yc }r- cc <br />Violation #104 -Failure to have an approved UST Monitoring Plan. <br />r. <br />❑ This violation was corrected Sri <br />This violation will be corrected by (date): ��� i o�U , .7�j'71 <br />❑ Supporting documents included <br />Describe actions taken or will be taken to correct violation: <br />Violation #107 -Failure to submit and maintain complete and Durrant financial responsibility documents. <br />/1 <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: ��k� , �t 1��.P.r� i,', <br />Rev. 9/16/2020 <br />�'-��� � , •,{� �~,{ <br />Page 2 of 5 <br />1868 E. Hazelton Avenue � Stockton, California 95205 � T 209 463-3420 � F 209 464-0133 � www.sjgov.org/EHD <br />