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s A N N Environmental Health Department <br /> C, 0LJN7FY <br /> Corrective Action Statement <br /> RE : November 18 , 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 . 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 /> Vicky Vang-Lee at (209 ) 616-3028 or . <br /> GRIN INVESTMENTS INC DBA : ARCO AM /PM , 6009 N EL DORADO ST , CERS ID : 10776040 , <br /> Violation #116 - Failure to submit the "Spill Container Testing Report Form " within 30 days . <br /> 't 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 /> (A) C tn� �— >L ) � V " - (a � 'i vy ►u Tt3 71 t v r L� <br /> {� >✓ Su 13 l\-r f77 to La 97H Iti Z .1 (� - <br /> Violation #122 - Failure to implement corrections and submit written response within 30 days of receiving <br /> the report . <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 /> > ( at I t -- JcJ � fMts t � - (3F Sj at - 177z-Y� <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 /> fns C I L-i 1 � S j 1r)�t! 12�o c--cam Kj A � <br /> III <br /> Page 4 of 6 <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 />