Laserfiche WebLink
SAN ) OAS U I N � � v � � � � �t � � i':�, o �- � � � � ,�: �� y ) � ,� � �• ,� rr�� r� rr, ;;, <br /> rlI r <br /> Corrective Action Statement <br /> RE : August 27 , 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 . <br /> Also , describe what was done to correct the violation in the space provided below each violation . Submit this <br /> completed form with the Return to Compliance Certification within 30 days of inspection . If you have any questions , <br /> please contact Shewit Woldearegay at (209) 468-0216 or stwoldearegay@sjgov. org . <br /> Submit completed form to : <br /> Facility name: Pilot Travel Center Lathrop - 1017 SJC ENVIRONMENTAL HEALTH <br /> Facility address : 345 Roth Rd DEPARTMENT <br /> CERS ID: 10726990 ATTN : SHEWIT WOLDEAREGAY <br /> 1868 E HAZELTON AVENUE <br /> PR0540987 <br /> Violation #124 - "Overfill Prevention Equipment Inspection Report Form" not submitted within 30 days of <br /> inspection . <br /> Id 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 /> Overfill prevention testing performed on 10/ 11/ 18 and submitted on 11/ 13/2018 was submitted 33 <br /> days later, absent of the 30 day time limit . In the future, all reporting will be submitted on time . <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 : <br /> Please find attached amended Designated Operator Reports , explaining " N /A" marks in unexplained areas . <br /> Page 1 of 2 <br /> 1868 E . Hazelton Avenue i Stockton , California 95205 1 T 209 468-3420 1 F 209 464 -0138 1 www. sjcehd . com <br />