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SAN J UAu U I N Envirdnrnantal Hpalth Department <br /> f <br /> ( )UNI Y <br /> Corrective Action Staterrwnt <br /> HL: Docambor 00, 2022. Undrrrcirounrl 174ornge Tank Inapor.tirin rPprlrt <br /> For ouch violation llntod below,Indicate If Ilse vinlalinn I1aq been 00frAMAd of will fin rnrror,lerl by a rorinln date <br /> Also,describe what wns done to correct Ilia violation In the apace PMvlded below each vinlatirm. Ruhmll thlq <br /> completed form with the Rnium in Compliance Certification within 30 days of(nepeetinn, If yrnr have any rri iegflr ne <br /> Please contact Krlallns Snotern at(208)810-3046 of ksaatamQgjgov.erq. <br /> ESCALON MINI MART, 1097 YOSEMITE AVE, CERS ID: 1011105411, PR0231407 <br /> Violation#115-Failure to submit"Monitoncng Sy-lam Cnrtlnrallon Form"wlthln ]o clays of r.ompl-llon of lb. <br /> test. <br /> Thla violation was corrected ❑This violation will be corrected by(data)'. <br /> W' Supporting documents Included II A <br /> // // <br /> Describo actions taken or will be taken to correct violation: _��C r'r_!r fit/ �r).!'i ��i 1:c1[1Itr1l.E.f <br /> Violation#116-Falluro to submit tho"Split Container Tosting Report Form"wlthhi 30 clays. <br /> 0 This violation was corrected ❑This violation will ho corrnctnd by(date); <br /> ❑ Supporting documents Included <br /> Describe actions taken or will be taken to correct violation; <br /> S-1 >,"141-14-11245Z r ALZ <br /> J / <br /> Violation#117-Failed to submit"Secondary Containment Testing Report Form"within 30 days after the lost. <br /> ❑ This violation was corrected E7Thls violation will be corrected by(date): �1. <br /> ❑ Supporting documents included `` / <br /> Describe actions taken or will be taken to correct violation:! , /)i'� lljl�,)e7 Tn 1/,/ <br /> Page 3 of 5 <br /> Rev,9/18/2020 <br /> 1868 E.Hazelton Avenue Stockton,California 952051 T 209 468-3420 1 F 209 464-0136 www sjgov.orgiEHD <br />