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2020 - 06 - 23 14005 TRACY TRUCK STOP 12098322312 > > P 2 / 17 <br /> . ^pC,1viYA� � �, .' <br /> e; , <br /> � Environmental Health Department <br /> lit , �w.lr ' . . ;,il r4 . :�. � � . <br /> : C : C7 N.T <br /> "a " 1 i �^ <br /> •`r . lfrrl ,t4M G ( rA � !'ll! Y 'St�' tGt1Y. ,l' fid; Yly <br /> Corrective Action Statement <br /> RE , April 22 , 2020 , Underground Storage Yank 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 slwoldearegav0,sl9ov. orq , <br /> Facility name : TRACY TRUCK AND AUTO STOP Submit completed form to: <br /> Facility address : 3940 N TRACY BLVD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : 10182335 ATTN ; SHEWIT WOLDEAREGAY <br /> PRO507837 1868 E HAZELTON AVENUE <br /> STOCKTON , CA 95205 <br /> Violation 0103 • F'ailuro to submit and maintain complete and current financial rosponsiblllty documents . <br /> 13This violation was corrected C3This violation will be corrected by (date ) : <br /> ❑' Supporting documents Included <br /> Describe actions taken or will be to correct violation ; <br /> Violation # 119 a Failure to submit "Monitoring System Certification Form " within 30 days of completion of the <br /> test. <br /> ( This violation was corrected ❑ This violation will be corrected by (dato) ; <br /> ❑ Supporting documents included <br /> Describe actions taken or will be taken to correct violation : ICAC) y a iWNC4r 1/1 (' <br /> l ll � ca�Q 0,r� V\ Q (- tL9— Lo Gia <br /> Rqv, 6127/2010 Page 2 of 3 <br /> 1 ARAE 952051 T 209 468-3420 1 F 209 464-0138 ( www. sjcehd . com <br /> Received Time Jun . 23 , 2020 4 ; 50PM No , 6046 <br />