Laserfiche WebLink
JA it I i n, r�rriranrlr�er�tal Health Department <br /> Corrective Action Statement <br /> RE: March 25, 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 Matthew Won at(209)616-3029 or MWON@SJGOV.ORG. <br /> Facility name: Yosemite Avenue Arco AmPm Submit completed form to: <br /> Facility address: 1711 E Yosemite Ave SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10422475 ATTN: MATTHEW WON <br /> PR0231455 1868 E HAZELTON AVENUE <br /> STOCKTON,CA 95205 <br /> Violation#106-Failure to submit and maintain a current facility plot plan f site map. <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: — <br /> �'�uF}ly!} 14-1 1 A`1E54I�1 t �YNGL `f��t�l�j �siv L6rr <br /> L` t�lli� t� lit:�� o1Qi glbjzLI . A (_.O.1 ��� &fiTACHED - <br /> Violation#107-Failure to submit and maintain complete and current financial responsibility documents. <br /> This violation was corrected D This violation will be corrected by(date): <br /> ® Supporting documents included <br /> Describe actionstakenor will be taken to correct violation: 1 ��C110I 1 P) Q E TRECti 0-11 E I CA 1 &4 <br /> C, �S��Y0tj 1_�IL_I 4,vIiS I�LLI� (c�NltlI,ECL1J l�rNl� �+P�Gf�t��a flb �-�fhS <br /> fi U to 2_q U,21 Ac A7-1 4 ED <br /> Page 2 of 2 <br /> Rev.911612020 <br /> 18CIS F I faze lon Avcmie. I Aockton, 7 201 )-t(l�t -120 I 1 _101` 414 0I:+: 111.11 SJ.L �f 1 �F iL <br />