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IEnvironmental Health Department <br /> SAN JOAQU <br /> Corrective Action Statement <br /> RE : October 16 , 2019 , 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 (209) 46&0216 or stwoldearegay@sjgov, org , <br /> Submit completed form to : <br /> Facility name : RANCHO SAN MIGUEL MARKET" SJC ENVIRONMENTAL HEALTH <br /> Facility address : 610 S Cherokee Ln DEPARTMENT <br /> CERS ID : 10184805 ATTN : SHEWIT WOLDEAREGAY <br /> 1868 E HAZELTON AVENUE <br /> PR0521866 <br /> Violation #106 - Failed to have an approved UST response plan . <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 : printed out a copy of the response plan on <br /> (CERS ) and will have a copy onsite <br /> Violation #118 - Failure to submit the " Underground Storage Tank Statement of Understanding and <br /> Compliance Form" . <br /> [r� 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 underground storage tank statement of <br /> understanding and compliance has been fill out and will have copies onsite . will upload on CERS <br /> and will submit with letter of correction . <br /> Page 1 of 3 <br /> I <br /> 1868 E . Hazelton Avenue Stockton , California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www, sjcehd . com <br />