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07 / 31 / 2020 15 : 02 5107963470 SHARII PAGE 03 <br /> .T;;� rrs <br /> 011 <br /> .:: o r Environmental Health Department <br /> ill rNIP, <br /> � <br /> i "i `f3 '•i2m It 4 <br /> c1. etee 9,y <br /> p!, <br /> sarySt07 <br /> Giti;fk{1 ,r�, '. ' ?? g:; !'t, tra=1 .; , 6 � t?vk " � PfY' r <br /> Corrective Action Statement <br /> RE. July 02 , 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. <br /> Also , describe what was done to correct the violation in the space provided below each violation . Submit this <br /> completed form with the Return to Compliance Certification within 30 days of inspection . If you have any questions , <br /> please contact Paul Nso at (209) 468- 3432 or pnso@sjgov . org . <br /> Facility name : Yosemite Avenue Arco AmPm Submit completed form to: <br /> Facility address : 1711 E Yosemite Ave 5JC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : 10422475 ATTN: PAUL NSO <br /> PR0231455 1868 E HAZELTON AVENUE <br /> STOCKTON , CA 95205 <br /> Violation #111 - Failed to test monitoring and leak detection equipment every 12 months. <br /> PoQ— <br /> ❑ This violation was corrected This violation will be corrected by (date) : jLLjEjT�5i1rSCv 5CNI,�p1J � ItVz�, <br /> 11 Supporting documents Included <br /> Describe actions taken or will betaken to correct violation : .DUG To , eip4aL.lEk thl t-Aec A* ► to Av A6iU1y <br /> © C= 17CrOAN \ C \ INNS 5ZIC41CC ULING OE TES°f1N 4 021: Lh T? EPe <br /> �( ouR. e.-: mnnrN7 � k4. 0 W � is r1o~r � D <br /> Violation 4201 - Failure to maintain monitoring, maintenance , and follow up action records . <br /> This violation was corrected ❑ This violation will be corrected by (date) : <br /> D Supporting documents Included <br /> Describe actions taken or will be taken to correct violation : IffLO NEA: LECopTAS kViTAE Now <br /> l�aCh3k 4 IVO R t� M!�EL4eb AND fkP:LA1IAcC (y�LE � t� $►T Tk�S � , r►1.��vfS <br /> vJE�E ofd S,'c� !4T THE j\ ME of I. WECTta1lS 1 �\ C WEIe� jtoT ifJ 41Z ER <br /> L.-Pr� <W USO [� \ ►.11�R <br /> Violation ¢#211 - No employee present that were trained In the operation and maintenance of the UST system <br /> by a Do . <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 : 400ii : Td Cpyt ,p ::S3 C� n1 ( �— K,11 i^ rvt f°tTI <br /> �Tokw OUT tS !A > TKMA Wj WIAdwu ONE. 79% Litj9D E%TAVLQIM WR < <br /> ►+vd(t. cMptoyEES `[g, K \ NcD E D sIGNAle P QfERkJ0I A \� tD T{ E✓�R � ups <br /> �E If, C�.uDED ►ti "ME uP �lr'Ci;D L� �r aF `TRA-Iti �' p sMPt- oy �Es.o ,,.._ _._ <br /> Ri iv. 8127?2019 Page 2 of 2 <br /> 1668 E . Hazelton Avenue 1 Stockton , California 952051 T 209 468%• 3420 1 F 2.09 464TIA0138 1 www. sicehd- cc� m <br /> Received Time Jul . 31 , 2020 5 : 03PM No . 6134 <br />