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Environmental Health Department <br /> IF I <br /> FF SAN IrJOAQUIN <br /> .. . tJ 1\1 T <br /> Corrective Action Statement <br /> RE : January 31 , 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 <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 : JOSS TRAVEL PLAZA Submit completed form to : <br /> Facility address : 15600 S HARLAN RD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : 10180541 ATTN : PAUL NSO <br /> PR0231585 1868 E HAZELTON AVENUE <br /> STOCKTON , CA 95205 <br /> Violation #115 - Failure to submit "Monitoring System Certification Form " within 30 days of completion of the <br /> testa <br /> &/ <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 AJt <br /> LH S' c <br /> (' <br /> Violation #116 anFailure to submit the "Spill Container Testing Report Form " within 30 days. <br /> to/This violation was corrected ❑ This violation will be corrected by (date) : <br /> ❑ Supporting documents included <br /> Describe actio s taken or will be take to correct violation � � U V <br /> �V ) ' <br /> Page 2 of 2 <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 />