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RECEIVED SAN 10 A Q U I NEnvironmental Health Department SEP 3 0 2020 ENVIRONMENTAL HEALTH Corrective Action Statement PERMIT / SERVICES RE : August 25 , 2020 , Underground Storage Tank inspection report For each violation listed below , indicate if the violation has been corrected or will be corrected by a certain date. Also , describe what was done to correct the violation in the space provided below each violation . Submit this completed form with the Return to Compliance Certification within 30 days of inspection . If you have any questions , please contact Paul Nso at (209 ) 468-3420 or pnso@sjgov. org . Facility name : Delta arco Submit completed form to: Facility address : 440 W DR MARTIN LUTHER KING JR BLVD SJC ENVIRONMENTAL HEALTH DEPARTMENT CERS ID : 10180903 ATTN: PAUL NSO PR0231055 1868 E HAZELTON AVENUE STOCKTON , CA 95205 Violation #103 - Failure to submit and maintain complete and current financial responsibility documents . 0 This violation was corrected ❑ This violation will be corrected by (date ) : ❑ Supporting documents included \\AA I ++ \ Describe actions taken or will be taken to correct violation : d \ 4s b �zv� �c �bvr" d �c� � . ��' , C k , Violation #107 - Plot plan/site map not submitted or failed to completely show where monitoring is performed Cl This violation was corrected ❑ This violation will be corrected by (date ) : ❑ Supporting documents included Describe actions taken or will be taken to correct violation : s Violation #113 - Failure to submit " Monitoring System Certification Form " within 30 days of completion of the test. C77 This violation was corrected ❑ This violation will be corrected by (date) : ❑ Supporting documents included P Describe actions taken or will be taken to correct violation : V ` U ono � \ (w Py) aln . Page 2 of 4 Rev. 8/18/2020 1868 E . Hazelton Avenue I Stockton , California 95205 1 T 209 468-3420 1 F 209 464 -0138 1 www . sjgov . org /EHD