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SAN JOAQUIN Environmental .Health Department <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 1-5 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 /> X— This violation was corrected D This violation will be corrected by(date): <br /> Supporting documents included ( r <br /> Describe actions taken or will be taken to correct violation: T di C)C- 0 ✓�^its � 'L <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): �C� In - �') r LA <br /> 13 Supporting documents included r <br /> Describe actions taken or will be taken to correct violation: " U —A- iluzi,- <br /> LAI d c.A- L f A-. %.cN"k'L-c I C(V\ VXIZA"P -a V VVN 6n I <br /> Violation #209 -Failure to conduct the designated UST operator visual inspection at least once every 30 <br /> days. <br /> 0 This violation was corrected l This violation will be corrected by (date): C L` T o 1 V <br /> 0 Supporting documents included <br /> Describe actions taken or will be taken to correct violation: rti-e� 61- <br /> Page 2 of 3 <br /> Rev.812712019 <br /> 1868 E. Hazelton Avenue i Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www-sjcehd.com <br />