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Environmental Hpalth DPpa�tmpnt <br /> SAN I OAQ U I N <br /> ` tirnolneif grnrvt hFrr <br /> Corrective Action Statement <br /> RE; December 00, 2022, Underground Storage Tank inspertion report <br /> For each violation listod below,Indicate If Ilia violation has been corrected of will be corrected by a certoin date. <br /> Also,describe whnl was done to correct tho violntlon in the apnco provided below each violailon. Submit thiq <br /> completed form with tho Return to Complinneo Cerilfleatlon within 30 days of Inspection. It ynu have any yIggtlrinq. <br /> Please contact Kristina Snolorn nt(200)016-3046 or kwinlyrriCafgov.org, <br /> ESCALON MINI MART, 1097 YOSEMITE AVE, CERS 10: 10160561, P1130231497 <br /> Violation#118-Failure to submit the "Overfill Proventlon Equipment Inspaetlon Report Form"within 30 t1srys. <br /> Ea� This violation was corrected ❑This violation will ba corractod by(date): <br /> ❑ Supporting documents Includod <br /> Describe actions taken or will be taken to correct violation: an it,, <br /> Violation#122-Failure to implement corrections and submit written responso within 30 days of racolving the <br /> report. <br /> &r'�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: llzal& /Z <br /> Violation#203-Failure to maintain monitoring records for 36 months and maintenance records for 60 <br /> months. <br /> This violation was corrected Q This violation will be corrected by(date): <br /> ❑ Supporting documents included <br /> Describe actions taken or will be taken to correct violation: e 11,WZ16 =' <br /> lr��� l n �• f <br /> Page 4 of 5 <br /> Rev.9/1612020 <br /> 1868 E. Hazelton Avenue j Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.orglEHD <br />