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SAW-I0AQU1 N Environmental Health Department <br /> I" yl o nt r <br /> �c+a * Grtotntss grams here <br /> Corrective Action Statement <br /> RE: February 05, 2024, 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 Carol Presto at(209)616-3061 or cpresto@sjgov.org. <br /> Facility name: A&A GAS& FOOD MART Submit completed form to: <br /> Facility address: 16 E HARDING WAY SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10181239 ATTN: CAROL PRESTO <br /> PR0231136 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#107-Failure to submit and maintain complete and current financial responsibility documents. <br /> © This violation was corrected ❑This violation will be corrected by(date): �z <br /> ❑ Supporting documents included <br /> Describe actions taken or will be taken tocorrectviolation: (,r V e! �I <br /> Violation#109-Failure to submit"Designated Underground Storage Tank Operator Identification Form" <br /> within 30 days. <br /> This violation was corrected ❑This violation will be corrected by(date): Zz <br /> ❑ Supporting documents included I <br /> Describe actions Jtaken or will betaken to correct violation: )� 1--7// <br /> / <br /> rr-h le-C Sy7 r- Ty L3/VY f,l�'S lit` V/2,112 fJ+� <br /> Page 2 of 3 <br /> Rev.9h 612020 <br /> 1868 nc.Hazelton Avenue i Stockton,California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />