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SAN 10 A Q U I N Environmental Health Department <br /> Corrective Action Statement <br /> RE : July 29 , 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) 468-0216 or stwoldearegay@sjgov. org . <br /> Facility name : Lawrence Livermore National Lab - Site 300 Submit completed form to : <br /> Facility address: 15999 W CORRAL HOLLOW RD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : 10154767 ATTN : SHEWIT WOLDEAREGAY <br /> PR0231945 1868 E HAZELTON AVENUE <br /> STOCKTON , CA 95205 <br /> Violation #115 - " Designated Underground Storage Tank Operator Identification Form" not submitted within <br /> 30 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 /> The new " Designated Underground Storage Tank Operator Identification Form" has been submitted on CERS . Please see <br /> Attachment 4 and 5 for the a copy of the updated form and CERS submittal receipt. <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 /> LLNL is requesting this violation be rescinded . <br /> Page 2 of 2 <br /> Rev. 8/27/2019 <br /> 1868 E . Hazelton Avenue I Stockton , California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www . sjcehd .com <br />