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20 <br /> SAN JOAQUIN Environmental Health Department <br /> {- <br /> III I r. j T <br /> Corrective Action Statement <br /> RE : March 12 , 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 <br /> form with the Return to Compliance Certification within 30 days of inspection . If you have any questions , please <br /> contact Paul Nso at (209 ) 468 -3432 or pnso@sjgov . org . <br /> Facility name : SHELL I -5 Submit completed form to : <br /> Facility address : 717 W EIGHTH ST SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : 10184915 ATTN : PAUL NSO <br /> PR0522448 1868 E HAZELTON AVENUE <br /> STOCKTON , CA 95205 <br /> Violation #103 - Failure to submit and maintain complete and current financial responsibility documents . <br /> ❑ This violation was corrected ❑ This violation will be corrected by (date ) : <br /> O Supporting documents included <br /> Describe actions taken or will be taken to correct violation : <br /> Violation #202 - Failure to maintain the " Facility Employee Training Certificate " on-site (after October 1 , 2018 ) . <br /> ❑ This violation was corrected ❑ This violation will be corrected by ( date) : <br /> Ell Supporting documents included <br /> Describe actions taken or will be taken to correct violation : <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 /> Page 2 of 3 <br /> Rev. 8/27/2019 <br /> 1868 E . Hazelton Avenue Stockton , California 95205 T 209 468 -3420 1 F 209 464 -0138 1 www . sjcehd . com <br />