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Environmental Health Department <br /> SAN 510AQUIN <br /> >t.I hJ ", AMENDED-2 <br /> Corrective Action Statement 112712025 <br /> RE: January 24, 2025, 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 form <br /> with the Return to Compliance Certification within 3D days of Inspection, If you have any questions, please contact .. <br /> Carol Presto at(209)616-3061 or cpiesto@sjgov.org. <br /> Facility name: KWIK SERV LODI BW 113* Submit completed form to: <br /> Facility address: 420 W KETTLEMAN LN SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERSID: 10181407 ATTN: CAROL PRESTO <br /> PR0231906 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#2 - 2010010 -Complete and accurate UST Operating Permit Application has been submitted.. <br /> ® This violation was corrected 1''This violation will be corrected by(date): <br /> ❑ Supporting documents Included <br /> Describe actions taken or will be taken to correct violation: <br /> I <br /> Violation #5 - 2030041 -A current facility plot plan is maintained and has been submitted.' <br /> IN 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: r <br /> �1e.t._� �QCt �() �_'ncscY �)?\ a,NPt 5t\ CYZ�. <br /> Violation #14. 2010018 -Overfill prevention equipment inspection report form submitted to the UPA within 30 <br /> days. <br /> Mi This violation was corrected ❑This violation will be corrected by (date): <br /> El Supporting documents included y � <br /> Describe actions taken or will be taken to correct violation: CGI fL S W ) � `K) f hives[, <br /> Page 2 of 4 <br /> Rov.9/re/202a <br /> 1868 E. Hazelton Avenue ( Stockton, California 952051 T 209 468-3420 i P 209 464-0138 1 www,sjgov.org/EHD <br />