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S A N J O A Q U I N Environmental Health Department <br /> C : _: NTY <br /> Corrective Action Statement <br /> RE : August 06 , 2019 , 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: LOVE' S COUNTRY STORES OF CALIF #223 Submit completed form to : <br /> Facility address : 1553 COLONY RD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : 10184317 ATTN .- SHEWIT WOLDEAREGAY <br /> PR0516526 1868 E HAZELTON AVENUE <br /> STOCKTON , CA 95205 <br /> Violation #105 - Failed to have an approved UST monitoring plan . <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 : <br /> This is not a violation because this is correct . Line testing is done yearly . <br /> Violation #204 - Current monitoring plan approved by the EHD not found on site . <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 : I was on Site on 2/ 19/2020 and printed and <br /> placed this in the front tab of the UST binder. <br /> Violation #209 - Failure to conduct the designated UST operator visual inspection at least once every 30 <br /> days . <br /> X! This violation was corrected ❑ This violation will be corrected by (date ) : <br /> if Supporting documents included <br /> Describe actions taken or will be taken to correct violation : The correct SB 989 date was placed on the <br /> December D . O . and signed . Going forward this will be signed by the day of the inspection . <br /> Page 2 of 2 <br /> Rev. 8/27/2019 <br /> 1868 E . Hazelton Avenue Stockton , California 95205 T 209 468-3420 1 F 209 464-0138 1 www. sjcehd . com <br />