Laserfiche WebLink
SAN Q N Environmental Health Department <br /> r ' - _ C 0U N T Y <br /> Corrective Action Statement <br /> RE : October 28 , 2019 , 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: QUIK STOP MARKET #3138 Submit completed form to : <br /> Facility address : 1153 LINCOLN BLVD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : 10181059 ATTN : SHEWIT WOLDEAREGAY <br /> PR0231413 1868 E HAZELTON AVENUE <br /> STOCKTON , CA 95205 <br /> Violation #105 - Failed to have an approved UST monitoring plan . <br /> EX 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 /> The UST monitoring plan was provided to site to maintain for future inspections . <br /> Violation # 121 - Failure to implement corrections and submit written response within 30 days of receiving <br /> the report. <br /> d 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 /> A written response documenting corrective actions taken will be submitted to the inspector within 30 days of receiving the inspection report <br /> for future inspections . <br /> Violation #201 - Failure to maintain monitoring , maintenance, and follow up action records . <br /> El 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 /> All records for the last 3 years have been located and are onsite for future inspections . <br /> Page 2 of 3 <br /> Rev. 8/27/2019 <br /> 1868 E . Hazelton Avenue I Stockton , California 95205 1 T 209 468-3420 1 F 209 464-0138 I www. sjcehd . com <br />