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SAN J 0 A Q U I N Environmental Health Department <br /> - i . _ - - - - COUNTY <br /> � ; � <br /> Corrective Action Statement <br /> RE : May 05 , 2020 , 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 form <br /> with the Return to Compliance Certification within 30 days of inspection . If you have any questions , please contact <br /> Shewit Woldearegay at (209) 468-0216 or stwoldearegay@sjgov. org . <br /> Facility name : FLYING J TRAVEL PLAZA #618* Submit completed form to : <br /> Facility address : 1501 N JACK TONE RD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : 10182131 ATTN : SHEWIT WOLDEAREGAY <br /> PR0505264 1868 E HAZELTON AVENUE <br /> STOCKTON , CA 95205 <br /> Violation # 103 - Failure to submit and maintain complete and current financial responsibility documents . <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 : The financial responslblllty documents <br /> were given to the site on 7/ 13/20 . <br /> Violation #107 - Plot plan/site map not submitted or failed to completely show where monitoring is <br /> performed . <br /> [I 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 : The monitoring site plan was corrected <br /> and submitted through CERS on 7/20/20 . The submittal status was accepted on 7/20/20 . <br /> Violation #110 - Failed to submit "Secondary Containment Testing Report Form " within 30 days after the test. <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 : From now on , the tests results will be <br /> submitted within the required timeframe . <br /> Page 2 of 3 <br /> Rev, 8/27/2019 <br /> 1868 E . Hazelton Avenue I Stockton , California 95205 1 T 209 468-3420 F 209 464-0138 1 www. sjcehd . com <br />