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SAN J O A Q U I N Environmental Health Department <br /> Corrective Action Statement <br /> RE : September 12, 2022, 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 dale. Also , <br /> describe what was done to correct the violation In the space provided below each violation. Submit this completed form <br /> with the Return to Compliance Certification within 30 days of inspection. If you have any questions, please contact <br /> Kristina Saetern at (209) 616-3045 or ksaetern@sjgov.org. <br /> Facility name: FOOD MART GASOLINE' Submit completed form to: <br /> Facility address: 2185 E FREMONT ST SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : 10181081 ATTN : KRISTINA SAETERN <br /> PR0231118 1868 E HAZELTON AVENUE <br /> STOCKTON , CA 95205 <br /> Violation #107 - Failure to submit and maintain complete and current financial responsibility documents. <br /> ~ P' 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 /> cui}1EvT /"i he= l f > ltr _ F', ff_d f G�c ;ti, . , ora r, Ca. ,1/ rn -{ rt tit <br /> Violation #116 - Failure to submit "Monitoring System Certification Form" within 30 days of completion of the <br /> test. <br /> 0d 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 /> h1` �4f41v2i . t)Y" h � ) tTYl.{ : a � �; iA�. i / rAr �. t.� r t, :�•". .lh . A.. t� <br /> �. �: � lA� ! +'yti �}� . •utk , C? U.-'� iy , ��.. YL.n. r.�"�, <br /> Page 2 of 2 <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 />