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Environmental Health Department <br /> SAN JOAQUIN <br /> Corrective Action Statement <br /> RE : June 17 , 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 Woldearepay at (209) 468-0216 or stwoldearegayftsigov.org . <br /> Facility name: WINE COUNTRY STATION/7-ELEVEN Submit completed form to: <br /> Facility address: 1111 E KETTLEMAN LN SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10182257 ATTN: SHEWIT WOLDEAREGAY <br /> PRO506724 1868 E HAZELTON AVENUE <br /> STOCKTON , CA 95205 <br /> Violation #124 " "Overfill Prevention Equipment Inspection Report Form" not submitted within 30 days of <br /> inspection . <br /> ❑ This violation was corrected ❑ This violation will be corrected by (date) : <br /> ❑ Supporting documents included j - <br /> Describe actions taken or will be taken to correct violation : \j �e ice- GU 'IL 8124 <br /> I " go Cs�i e � 1 � �t w : � VI <br /> If <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 /> L (� �1` Z <br /> I <br /> i <br /> G <br /> Page 2 of 2 <br /> Rov. 8/2712019 <br /> 1868 E . Hazelton Avenue Stockton , California 95205 1 T 209 468-3420 F 209 464-0138 1 www . sjcehd .com <br />