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SAN JOAQUIN Environmental Health Department Corrective Action Statement RE : March 04 , 2024 , Underground Storage Tank inspection report . For each violation listed below, indicate if the violation has been corrected or will be corrected by a certain date . Also, describe what was done to correct the violation in the space provided below each violation . Submit this completed form with the Return to Compliance Certification within 30 days of inspection . If you have any questions , please contact Paul Nso at (209 ) 616-3049 or pnso@sjgov .org . Facility name : COUNTRY MART GAS & FOOD Submit completed form to : Facility address : 34243 S CHRISMAN RD SJC ENVIRONMENTAL HEALTH DEPARTMENT CERS ID : 10181085 ATTN : PAUL NSO PR0231801 1868 E HAZELTON AVENUE STOCKTON , CA 95205 Violation #115 - Failure to submit " Monitoring System Certification Form " within 30 days of completion of the test . P This violation was corrected ❑ This violation will be corrected by (date) : ❑ Supporting documents included ' Describe actions taken or will be taken to correct violation : F -� �' , ;vc C yLi JV J U- r OL %t) &A4,A0v e L, IL4CL, Violation #116 - Failure to submit the "Spill Container Testing Report Form " within 30 days . IN This violation was corrected ❑ This violation will be corrected by (date) : ❑ Supporting documents included Describe actions taken or will be taken to correct violation : Violation #208 - Failure to comply with the designated operator inspection requirements . ❑ This violation was corrected ❑ This violation will be corrected by (date) : ❑ Supporting documents included Describe actions taken or will be taken to correct violation : 1 � . _ . LOA wry co±tfir. e0 .1,P e% Page 2 of 2 Rev. 9/16/2020 1868 E. Hazelton Avenue I Stockton , California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www. sjgov.org/EHD