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SANaIOAQUIN Environmental Health Department <br />x H U <br />--,COUNTY---- <br />Corrective <br />COUNTY- -- <br />Corrective Action Statement <br />RE: April 03, 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 />SUPER STOP GAS & LIQUOR*, 290 N MAIN ST STE C, CERS ID: 10181339, PR0231438 <br />Violation #115 - Failure to submit "Monitoring System Certification Form" within 30 days of completion of the <br />test. <br />GY"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: W f J) z-5 V 6 M 1-T tAJ I fh JN 30 DAYS" <br />IN 2E <br />Violation #116 - Failure to submit the "Spill Container Testing Report Form" within 30 days. <br />9 -"'"This violation was corrected ❑ This violation will be corrected by (date): <br />❑ Supporting documents included L p" <br />Describe actions taken or will be taken to correct violation: I L Z— z5Uig rnl i W gyet I li Yl 30 DWS <br />LJ V <br />Violation #122 - Failure to implement corrections and submit written response within 30 days of receiving the <br />report. <br />0 This violation was corrected ❑ This violation will be corrected by (date): <br />❑ Supporting documents includedI <br />Describe actions taken or will be taken to correct violation: In) i 1 5� 1+r11 1 IQi()>n <br />Page 3 of 5 <br />Rev. 9/1612020 <br />1868 E. Hazelton Avenue i Stockton, California 952051 T 209 468-3420 i F 209 464-0138 i www.sjgov.org/EHD <br />Scanned with CamScanner <br />