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RECEIVELI FEB 041010 VRit SAN 10AQUINEnvironmental eal�h1p Wh <br /> COUNTY FEB 18 2020 <br /> Greotness grows Dere , <br /> ENVIRONMENTAL HEALTH <br /> Corrective Action Statement PERMIT/ SERVICES <br /> RE : January 02 , 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 stwoldearegayPsjgov. orp . <br /> Facility name: CHEVRON USA #201761Submit completed form to . <br /> Facility address: 1103 S MAIN ST SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : 10181653 ATTN : SHEWIT WOLDEAREGAY <br /> PR0232587 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 /> IX 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 : The Overfill report was submitted . <br /> Unfortunately this was a learning and it was tardy . It is not our intention to be late in <br /> submissions . <br /> Violation #209 • Failure to conduct the designated UST operator visual inspection at least once every 30 <br /> days . <br /> IX 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 : Copy of Corrected DO report attached <br /> i <br /> i <br /> Rev emnois Page 2 of 2 <br /> 1868 E Hazelton Avenue Stockton , California 952051 T 209 468-3420 1 F 209 464 -0138 1 www sjcehd . com <br />