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�l ►I�� aAl I I N Environmental Health Department <br />��• x <br />L-'r'.`' j COUNTY <br />ro- Greatness grows here. <br />Corrective Action Statement <br />RE: September 08, 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 Shewit Woldearegay at or stwoldearegay(o),sigov.orq. <br />Facility name: Tracy Texaco Submit completed form to: <br />Facility address: 2375 N TRACY BLVD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br />CERS ID: 10182109 ATTN: SHEWIT WOLDEAREGAY <br />PR0231897 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: <br />Violation #110 - Failed to submit "Secondary Containment Testing Report Form" within 30 days after the test. <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 />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: <br />Page 2 of 4 <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 />