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SKJOAQUIN Environmental Health Department <br /> . � . <br /> COUNTY— <br /> C,reotness grows here. <br /> Corrective Action Statement <br /> RE: August 25, 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)468-3420 or pnso@sjgov.org. <br /> Facility name: Delta arco Submit completed form to: <br /> Facility address: 440 W DR MARTIN LUTHER KING JR BLVD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10180903 ATTN: PAUL NSO <br /> PR0231055 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 /> ❑ Supporting documents included <br /> Describe actions taken or will be taken to correct violation: <br /> Violation#107 - Plot plan/site map not submitted or failed to completely show where monitoring is performed <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 /> Violation#113 - 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 (date): <br /> ❑ Supporting documents included <br /> Describe actions taken or will be taken to correct violation: <br /> Page 2 of 4 <br /> Rev.8/18/2020 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />