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SAN 1 O A Q U I N Environmental Health Departrne n <br /> Corrective Action Statement <br /> RE-January 05, 2022, Underground Storage Tank inspection report <br /> For cacti 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 0elow each violation. Submit this <br /> completed form with the Return to Compliance Certification within 30 days of inspection, If you have any questions, <br /> }Tease contact Kristina Saetem at(209)616-3045 or ksaetern@sjgay.org. <br /> Facility name: RIPON SHELL' Submit completed form to: <br /> Facility address: 3-41 E MAIN ST SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10181381 ATTN: KRISTINA SAETERN <br /> PR0231477 1$58 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#107-f=ailure to submit and maintain complete and current financial responsibility documents. <br /> �Zlolatlon was corrected ❑This violation will be corrected h (date); <br /> 1 <br /> E1 Supporting documents Included <br /> Describe actions taken or%vill be taken to correct vicJatiory I �-t i5 l=am jj '75 Po(VS tff,r <br /> R--6- <br /> Violation#208-Failure to comply with the designated operator inspection requirements. L' t <br /> -���r� ✓v2�--rtr L�Z- t,"1 T <br /> O This violation was corrected ❑This violation will be corrected by(date): � <br /> ❑ Supporting documents included [ C�:7 r� N <br /> Describe actions taken or will he taken to correct vitiation: W-( Lltn' a Co N i I~K 7t Q t� <br /> Page 2 of 2 <br /> 126$E. Har_elion Avenue] Stockton. California 95205 1 T 209 469-3420 1 F 209 4&1-0138 1 www.slgoV.otgtEHD <br />