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#r" a■ Environmental Health Department <br /> ' v `� <br /> .. <br /> Corrective Action Statement <br /> RE: May 20, 2020, Underground Storage Tank inspection report <br /> For each violation listed belaw,indicate if the violation has been corrected or wilt be corrected by a certain data <br /> Also,describe whet was done to correct the violation in the space provided below each violation. Submit this <br /> completed form with the Return to Compliance Cer6hcatlon wfthln 30 days of Inspection. If you have any questions, <br /> please contact Paul Wo at(209)40H-M2 or pnso(%sjgcv.org. <br /> Facility name: FLAG CITY CHEVRON Submit completed form to: <br /> Fecilltyaddress: 8421 CAPITOL.AVE SJC ENVIRONMENTAL.HEALTH DEPARTMENT <br /> CERS ID: 10180605 ATI-N:PAUL NSO <br /> PRO231700 1888 E HAZELTON AVENUE <br /> STOCKTON,CA 95205 <br /> Violation#103-Failure to submit and maintain complete and current financial responsiblilty documents. <br /> R/Thls violation was corrected l7 This violation VIII be corrected by(date): <br /> >� Supporting documents included <br /> Describe scions taken or will be taken to correct violation: Financial responsibility was submitted on <br /> 4/29/2020 (see attached) and maintain a copy on site. <br /> Violation#113-Failure to submit"Monitoring System Certificatlon Form"wlthln 30 days of completion of the <br /> 1"t <br /> H' This violation was corrected p This violation will be corrected by(date): <br /> 13 Supporting documents included <br /> Describe actions taken or will be taken to correct violation: l will ensure tesUno and submittal of test <br /> reports are performed in timely manner <br /> Violation#201 -Failure to maintain monitoring,maintenance,and follow up action records. <br /> This violation was corrected 0 This violation will be corrected by(date): <br /> Supporting documents Included <br /> Describe actions taken or will be taken to correct violatlon: Enclosed please find 2018 monitoring <br /> system certit•+cation test results for your record. <br /> Page 2 of 3 <br /> �,.arnno,a <br /> 1068 E.Hazelton Avenue l Stockton, California 95205 17 209 45&34201 F 209 484-0138 1 www.sjcehd.com <br />