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SAN JOAQUIN Environmental Health Department <br /> C C) 1 i ('•; T Y <br /> Corrective Action Statement <br /> RE : June 16 , 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 : Yosemite Avenue Arco AmPm Submit completed form to: <br /> Facility address: 1711 E Yosemite Ave SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : 10422475 ATTN : PAUL NSO <br /> PR0231455 1868 E HAZELTON AVENUE <br /> STOCKTON , CA 95205 <br /> Violation #208 - Failure to comply with the designated operator inspection requirements, <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 : C CAMEtJT4, KO TE tp /wN p D45 CUSSED <br /> Wi'CK Tt�E �F�,1 [� Nr�TE� nPEt2t*To2 To ftEq 1pb Wi ViSUftL INSPECTION D U-tEUL <br /> A� qa umef) 1TirMs ON TSE, t�mw m9privED Fo m <br /> Violation #209 - Failure to maintain a copy of the "Facility Employee Training Certificate" on-site. <br /> 7WNThis violation was corrected 13 This violation will be corrected by (date) : <br /> ❑ Supporting documents included <br /> Describe actions taken or will be taken to correct violation : <br /> THE ATTA.CHr"0 fiAUt..\Ty EIMPwvt 'TP�RtNIntG ELI IF CA7E is UPBAT 0 Wirt] <br /> THE K 1AVONT PLME t4OTE 7k4A'[ EiMPt-oyEES HIRED `/ EA*S EGD <br /> W ELLE Mi6o nNNkNefl Eve N <br /> Page 2 of 2 <br /> Rev. 9/16/2020 <br />