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S A N J 0 A n U I N Environmental Health Department <br /> r- .,,r , <br /> Corrective Action Statement <br /> RE : April 25 , 2023 , 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 form <br /> with the Return to Compliance Certification within 30 days of inspection . If you have any questions , please contact <br /> Paul Nso at (209) 616- 3049 or pnso@sjgov . org . <br /> Facility name : MANTECA LIQUOR & FOOD Submit completed form to : <br /> Facility address : 890 N MAIN ST SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : 10180741 ATTN : PAUL NSO <br /> PR0231984 1868 E HAZELTON AVENUE <br /> STOCKTON , CA 95205 <br /> Violation # 104 - Failure to submit a complete and accurate UST Monitoring Plan . <br /> 01 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 /> Violation # 107 - Failure to submit and maintain complete and current financial responsibility documents . <br /> ❑ 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 /> Violation #122 - Failure to implement corrections and submit written response within 30 days of receiving <br /> the report. <br /> ❑ 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 : � ,, P <br /> Page 2 of 4 <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 />