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SAN �� IIIN Environmental Health Department <br /> -CauNTY <br /> Greotness grows here. <br /> r. <br /> Corrective Action Statement <br /> RE: October 27, 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. <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)616-3063 or stwoldearegay@sjgov.org. <br /> Facility name: H&S Energy Products,#3034 Submit completed form to: <br /> Facility address: 1434 W Yosemite Ave SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10169781 ATTN: SHEWIT WOLDEAREGAY <br /> PR0231465 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#104-Failure to have an approved UST Monitoring Plan. <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#203-Failure to maintain monitoring records for 36 months and maintenance records for 60 <br /> months. <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#205-Failure to have current UST Monitoring Plan readily accessible at the facility. <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.9/16/2020 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />