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SAN : WOUIN Environmental Health Deparbmnt <br /> c ra r .}; <br /> Corrective Action Statement <br /> RE: June 24, 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 /> Facility name: ER Vine Stockton Submit completed form to: <br /> Facility address: 4733 S HWY 99 SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10399867 ATTN: PAUL NSO <br /> PR0232510 1868 E HAZELTON AVENUE <br /> STOCKTON , CA 95205 <br /> Violation 9205 - Failure to submit a current UST Response Plan and have it available onsite. <br /> d 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: 6/27/20 put copy into binder at site <br /> Violation #209 - Failure to conduct the designated UST operator visual inspection at least once every 30 <br /> days. <br /> ❑ This violation was corrected IdThts violation will be corrected by (date): <br /> ❑ Supporting documents Included <br /> Describe actions taken or will be taken to correct violation: 6/27/20 went over missing line items with tech <br /> so this does not happen again. <br /> Violation #319 - No spill bucket, failed to contain 5 gallons, no means to keep it empty, or failed to be tested. <br /> ❑ This violation was corrected ❑ This violation will be corrected by (date) : <br /> M' Supporting documents Included <br /> Describe actions taken or will be taken to correct violation: 7/21 /2020 <br /> Bucket looks to be damaged due to vandalism , cuts at top of bucket. Submitted permit application to <br /> install new bucket. <br /> Page 2 of 2 <br /> Rev. W27/2019 <br /> 1868 E. Hazelton Avenue i Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd,com <br />