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S A N, 0 QQ U I N Environmental Health Department <br />—COUNTY— <br />�� GrfctneS% grows here <br />Corrective Action Statement <br />RE: May 25, 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 date, Also, <br />describe what was done to correct the violation in the space provided below each violation. Submit this completed <br />form with the Return to Compliance Certification within 30 days of inspection. If you have any questions, please <br />contact Paul Nso at (209) 616-3049 or pnso@sjgov.org. <br />Facility name: fast and easy mart #103 Submit completed form to: <br />Facility address: 8660 LOWER SACRAMENTO RD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br />CERS ID: 10181351 ATTN: PAUL NSO <br />PR0231161 1868 E HAZELTON AVENUE <br />STOCKTON, CA 95205 <br />Violation #107 - Failure to submit and maintain complete and current financial responsibility documents. <br />❑ This violation was corrected O�Thls violation will be corrected by (date): <br />d Supporting documents included , <br />Describe actions taken or will be taken tocorrect <br />(c}orrect violation: <br />V\ C,.\ i)1�2 4\ 1"nc.1Y� • rA -�Vo <br />Violation #117 - Failed to submit "Secondary Containment Testing Report Form" within 30 days after the test. <br />❑ This violation was corrected This violation will be corrected by (date): <br />'0 Supporting Supporting documents included <br />Describe action taken or will be taken to correct violation: <br />Violation 9203 - Failure to maintain monitoring records for 36 months and maintenance records for 60 <br />months. <br />❑ This violation was corrected P}jhis violation will be corrected by (date): Z 2Z- <br />4�7 Supporting documents included <br />Describe actions taken or will be taken to correct violation: PCyu r e- t,,\ i _yy, Ij <br />1n�� i'�'��'�c S✓!`�� 1� WGn�� �i}tie�,^ U�G�\v� � _ <br />Page 2 of 4 <br />Rev. Wl&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 />