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S A N J O A Q U I N Environmental Health Department <br /> Corrective Action Statement <br /> RE: November 16, 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. <br /> Also,describe what was done to correct the violation in the space provided below each violation. Submit this <br /> completed form with the Return to Compliance Certification within 30 days of inspection. If you have any questions, <br /> please contact Vicky Vang-Lee at(209)616-3028 or vvang-lee@sjgov.org. <br /> Facility name: KISHIDA, GEORGE INC Submit completed form to: <br /> Facility address: 1725 ACKERMAN DR SJC ENVIRONMENTAL_HEALTH DEPARTMENT <br /> CERS ID: 10181383 ATTN:VICKY VANG-LEE <br /> PR0231309 1868 E HAZELTON AVENUE <br /> STOCKTON,CA 95205 <br /> Violation#202-Failure to retain a paper or electronic copy of the permit to operate at the facility. ! <br /> ❑ This violation was corrected This violation will be corrected by(date): <br /> Supporting documents included <br /> Describe actions takan nr will ha takan to rnrrart violation: A P <br /> �i �ti fi l S i a t-s 4s1'�l <br /> Page 2 of 2 <br /> Rev.9/16/2020 <br /> 1868 E. Hazelton Avenue J Stockton,California 95205 1 T 209 468-3420 1 F 209 464-0938 1 www.sjgov.org/EHD <br />