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SAN J O A Q U I N Environmental Health Department <br /> Corrective Action Statement <br /> RE: September 27, 2021, 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 Vicky Vang-Lee at(209)616-3028 or vvang-lee@sjgov.org. <br /> Facility name: LODI MEMORIAL HOSPITAL Submit completed form to: <br /> Facility address: 975 S FAIRMONT AVE SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10180611 ATTN:VICKY VANG-LEE <br /> PR0231331 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#208-Failure to comply with the designated operator inspection requirements. <br /> W-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: f'o e, [��sC J'01 <br /> *7 r 01 t <br /> Violation#315-Failure to maintain interstitial space to detect leaks before release to environment(post-Jul <br /> 2004). <br /> his violation was corrected ❑This violation will be corrected by(date): <br /> Uk"'upporting documents included <br /> Describe actions taken or will be taken to correct violation: LZ L—;-2—e— <br /> G <br /> Page 2 of 2 <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 />