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SANJOAQUI Environmental Health Department <br /> COUNTY <br /> tic, v tlreatrress grows here. <br /> Corrective Action Statement <br /> RE: December 09, 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(d).sjgov.orq. <br /> Facility name: LATHROP GAS&FOOD INC Submit completed form to: <br /> Facility address: 140 E LATHROP RD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10182153 ATTN: SHEWIT WOLDEAREGAY <br /> PR0505687 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <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 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 1 www.sjcehd.com <br />