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SAN MQUIN Environmental Health Department <br />Corrective Action Statement <br />RE: May 23, 2022, Hazardous Materials 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: DBA CIRCLEK, REFUEL PETROLEUM INC. Submit completed form to: <br />Facility address: 419 S MAIN ST SJC ENVIRONMENTAL HEALTH DEPARTMENT <br />CERS ID: 10181307 ATTN: PAUL NSO <br />PR0519895 1868 E HAZELTON AVENUE <br />STOCKTON, CA 95205 <br />Violation #9 - Failed to annually review and certify that the HMBP is complete and accurate by the due date. <br />j�r This violation was corrected ❑ This violation will be corrected by (date): <br />❑ Supporting documents included 7 � <br />Describe actions taken or will be taken to correct violation: ► j /yi 1 / 1 1A3 PIS <br />LPsi7 tA9tL-1Q� is f�� t���-- rni�t.��io��t-Y �+t� G es <br />S`At3w\ "—CSS 9- \0\-2a2Z <br />Page 2 of 2 <br />Re, 9A6,2020 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 v, iww.sjgov.orgfEHD <br />