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.. Environmental Health Department <br /> SAN JOAQUIN <br /> - Y. firt'QIr1Cf3 r�rG�xS !lt`Y!'. <br /> Corrective Action Statement ort <br /> RE: February 15, 2022, Underground Storage Tank inspection report <br /> by a certain <br /> For each violation listed below, indicate if the violation has been a rrected or will be provided below each violation.n. Submit this te <br /> Also,describe what was done to correct the violation in the space p uestions, <br /> completed form with the Return to Compliance Certification within 30 days of inspection. If you have any q <br /> please contact Lydia Baker at(209)616-3046 or(baker@sjgov.org. <br /> Facility name: A&A GAS&FOOD MART <br /> Submit completed form to: <br /> SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> Facility address: 16 E HARDING WAY ATTN: LYDIA BAKER <br /> CERS ID: 10181239 1868 E HAZELTON AVENUE <br /> PR0231136 STOCKTON, CA 95205 <br /> violation#104-Failure to have an approved UST Monitoring Plan. <br /> /This violation was corrected ❑This violation will be corrected by(date): <br /> r <br /> ❑ Supporting documents included CQ <br /> Describe actions taken or wi I be taken to correct violation: <br /> G ,-3 <br /> 2� <br /> Violation#106-Failure to submit and maintain a current facility plot plan I site map. <br /> 911-This violation was corrected ❑This violation will be corrected by(date): <br /> ❑ Supporting documents included <br /> ill be taken to correct violation: <br /> Describe actions taken o wR dY� U U <br /> Violation 9109-Failure to submit"Designated Underground Storage Tank Operator Identification Form" <br /> within 30 days. <br /> his violation was corrected ❑This violation will be corrected by (date): <br /> 2f"T❑ Supporting documents included <br /> Describe actions taken or will be taken to correFt olati Q¢Q <br /> 171 <br /> v I �-ao <br /> Page 2 of 3 <br /> Rev 911612020 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 I www.sjgov.org/EH <br />