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SAN 10 A Q U I N Environmental Health Department <br /> CC) U r\ 1 f Y - <br /> Corrective Action Statement <br /> RE : August 10 , 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 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 stwoldearegay@sjgov. org . <br /> Facility name : KWIK SERVE Submit completed form to : <br /> Facility address : 950 W ELEVENTH ST SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : 10182093 ATTN : SHEWIT WOLDEAREGAY <br /> PR0231401 1868 E HAZELTON AVENUE <br /> STOCKTON , CA 95205 <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 : Ensure that designated operators perform visual inspection at least once <br /> every 30 days . <br /> Page 2 of 2 <br /> Rev, 8/27/2019 1868 E . Hazelton Avenue Stockton , California 95205 1 T 209 468-3420 I F 209 464-0138 1 www . sjcehd . com <br />