COMPLIANCE INFO_2020 - Laserfiche WebLink

Home Browse Search

i SAN J O A Q U I N Environmental Health Department c0uii\ITY Corrective Action Statement RE : November 06 , 2019 , Underground Storage Tank inspection report For each violation listed below, indicate if the violation has been corrected or will be corrected by a certain date . Also, describe what was done to correct the violation in the space provided below each violation . Submit this completed form with the Return to Compliance Certification within 30 days of inspection . If you have any questions , please contact Shewit Woldearegay at (209) 468.0216 or stwoldearegay(oDsigov. org . Facility name : Sutter Valley Hospitals dba Sutter Tracy Community F Submit completed form to: Facility address: 1420 N Tracy Blvd SJC ENVIRONMENTAL HEALTH DEPARTMENT CERS ID : 10397599 ATTN : SHEWIT WOLDEAREGAY PR0231736 1868 E HAZELTON AVENUE STOCKTON , CA 95205 Violation #103 • Failure to submit and maintain complete and current financial responsibility documents . 12/ This violation was corrected ❑ This violation will be corrected by (date) : ❑ Supporting documents included Describe actions taken or will be taken to correct violation : The Certification of Financial Responsibility Cover Page has been added to the Sutter Health dba Sutter Tracy Community Hospital Financial Responsibility that was submitted on 01 -31 -20 . We will re-submit for review and approval Violation #118 - Failure to submit the " Underground Storage Tank Statement of Understanding and Compliance Form " . FdliThis violation was corrected ❑ This violation will be corrected by (date) : ❑ Supporting documents included Describe actions taken or will be taken to correct violation : The UST Understanding and Compliance Form will be added to the Afforda-Test Operators Compliance list that was submitted on 01 -31 -20 . We will re -submit for review and approval Page 2 of 3 Rev. 8/27/2019 1868 E . Hazelton Avenue I Stockton , California 95205 1 T 209 468 -3420 1 F 209 464 - 0138 1 www. sjcehd . com