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AN JOAQ iN Environmental Health Department <br />- Ni T '�- <br />Corrective Action Statement <br />RE: January 21, 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 />PACIFIC AVE CHEVRON, 6633 PACIFIC AVE, CERS ICk 10594654, PR0231784 <br />Violation #121 - Failure to implement corrections and submit written response within 30 days of receiving the <br />report. <br />X 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 />Violation #201 - Failure to maintain monitoring, maintenance, and follow up action records. <br />X This violation was corrected ❑ This violation will be corrected by (date): <br />❑ Supporting documents included <br />Describe actions taken or will betaken to correct violation:-f�_.ES <br />Violation #209 - Failure to conduct the designated UST operator visual inspection at least once every 30 <br />days. <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 />Page 3 of 4 <br />Rev. 8/2712419 <br />1868 F. Hazelton Avenue I Stockton, California 952051 T 209468-34201 F 209464-0138 1 www.sjcehd.com <br />