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�ry"'^ n SANJOAQUI Environmental Health Department <br /> —COUNTY— <br /> Greatness grows here, <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 /> ❑ 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#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 /> 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 />