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S A N J O A Q U I N Environmental Health Department <br /> COUNTY <br /> : iPi <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 # 107 - Failure to submit and maintain complete and current financial responsibility documents . <br /> This violation was corrected ElThis violation will be corrected by (date) : <br /> ❑ Supporting documents included <br /> Describe actions taken or will be taken to correct violation : <br /> Violation #109 - Failure to submit " Designated Underground Storage Tank Operator Identification Form " <br /> within 30 days . <br /> 1 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 #115 - Failure to submit " Monitoring System Certification Form " within 30 days of completion of the <br /> test. <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 /> cls <br /> Page 3 of 6 <br /> Rev. 9/16/2020 <br /> 1868 E . Hazelton Avenue I Stockton , California 95205 1 T 209 468-3420 i F 209 464-0138 1 www. sjgov.org/EHD <br />