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S A N X10 AQ U I N Environmental Health Department <br /> - <br /> C+rnninr+}t orowt !tore <br /> Correx;tivo Action St,'ttE,rnf!nt <br /> RE: Drcernbnr 06, 2022, Underground Storriclp Tank ina,wr.tinn ropott <br /> For ouch vloinllon liatnd tinlow,Indicate If the vinlation has bean cortected or will h4 rnrror,lorl by a�nrlgln Igle <br /> Aloo,doncrihn what won Arno to norrart Ilia violation In the apace ptwldad below each violwinn q,ihmit Ihlq <br /> comploted form with thn Rolum to Compliance Cortlftcallnn within 30 days of Inspection If yap haves any rll Ipatlnn4, <br /> ploame contact Krlatlnn Snotem at(200)918-3045 or kaaelam(Ma)gov.org. <br /> Facility name ESCALON MINI MART Submit Completed form to <br /> Fncility nddrnss 1097 YOSEMITE AVE SJC FNVIRONMENTAI I.WWH DEphtxfMcrrT <br /> CERS ID: 10180561 ATTN;KAISTINA 9AETERM <br /> PR0231497 1099 E HAZELTON AVENIJE <br /> STOCKTON,CA 952n5 <br /> Violation#107-Failure to submit and malnt iln Complota and currow financial responsibility documerft. <br /> lid This violatlon was corrected ❑Tills violation will ba corractad by(data): <br /> ❑ Supporting documents Included <br /> Describe actions taken or will be taken to correct violation !: ii%Lr/1/ 7rl/Q/1P.IA� !_ lJrIl_,j /jt/ <br /> Violation#109-Failure to submit"Designated Underground Storage Tank Operator Idontlflcatlon Form" <br /> within30days. <br /> 51/This violation was corrected ❑This violation will be corrected by(dale): <br /> ❑ Supporting documents included <br /> Describe actions taken or will be taken to correct violation: <br /> ' <br /> Violation#111 -Failed to notify the EHD 48 hours prior to conducting testing. <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. °S <br /> i <br /> Page 2 of 5 <br /> Rev.9!1612020 <br /> 1868 E. Hazelton Avenue i Stockton. California 95205 1 T 209 468-3420 1 F 209 464-0136 www sigov org.EHD <br />