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AAnUIN Environmental Health Department <br /> COUNTY <br /> Corrective Action Statement <br /> RE : May 28 , 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) 46&0216 or stwoldearegay@sjgov. orq . <br /> Facility name: EMILS LIQUOR & SPORTS SHOP` Submit completed form to: <br /> Facility address: 1405 CALIFORNIA ST SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10180567 ATTN : SHEWIT WOLDEAREGAY <br /> PR0231485 1868 E HAZELTON AVENUE <br /> STOCKTON , CA 95205 <br /> Violation #103 - Failure to submit and maintain complete and current financial responsibility documents . <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 : Current Financial Responsibility form is <br /> kept in the CERS binder for reference . <br /> Violation #118 - Failure to submit the " Underground Storage Tank Statement of Understanding and <br /> Compliance Form". <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 : Underground Storage Tank statement of Understanding <br /> and compliance form is submitted on CERS . <br /> Violation #204 - Current monitoring plan approved by the EHD not found on site. <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 : Current monitoring plan approved by EHD is <br /> made available . <br /> Page 2 of 4 <br /> Rev. 8/27/2014 <br /> 1868 E . Hazelton Avenue Stockton , California 95205 T 209 46&3420 F 209 464-0138 i www. sjcehd . com <br /> i <br />