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SAN J O A Q U f N Environmental Health Department COUNTY GrEcsrness gro►�s h,,r, Corrective Action Statement RE: April 03, 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 Matthew Won at (209) 616-3029 or MWON@SJGOV.ORG. Facility name: SUPER STOP GAS & LIQUOR" Submit completed form to: Facility address: 290 N MAIN ST STE C SJC ENVIRONMENTAL HEALTH DEPARTMENT CERS ID: 10181339 ATTN: MATTHEW WON PR0231438 1868 E HAZELTON AVENUE STOCKTON, CA 95205 Violation #102 - Failure to submit a complete and accurate application for a permit to operate a UST. U This violation was corrected ❑ This violation will be corrected by (date): _- ❑ Supporting documents included Describe actions taken or will be taken to correct violation: CORQe - --e of O N Violation #104 - Failure to submit a complete and accurate UST Monitoring Plan. IS( This violation was corrected ❑ This violation will be corrected by (date): ❑ Supporting documents included Describe actions taken or will be taken to correct violation: C - a -p -s- - o rV 4- u 6w, 4, of -u6w,4,of ±2 -rt,.D re-tsc _ y- Violation #107 - Failure to submit and maintain complete and current financial responsibility documents. Rev. 9116!2020 P9 This violation was corrected ❑ This violation will be corrected by (date): ❑ Supporting documents included LqDescribe actions taken or wiil be taken to correct violation: _ y - O �e t.Je-re� 5U �rS — '2 Page 2 of 5 1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD Scanned with CamScanner