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S A N J O A Q U IN Environmental Health Department <br /> CnLJl\JTY <br /> Corrective Action Statement <br /> RE : February 09 , 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 /> SHOP N GO 3 , 4511 PACIFIC AVE , CERS ID : 10180943 , PR0231216 <br /> Violation #110 - Failure to submit the " Underground Storage Tank Statement of Understanding and <br /> Compliance Form " . <br /> tip' 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 #122 - Failure to implement corrections and submit written response within 30 days of receiving the <br /> report. <br /> ` � <br /> U 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 /> ,: i " i\` 4c,n� fll` �-- r;� — rf Ivy /y vo%� C WAX <br /> Violation #203 - Failure to maintain monitoring records for 36 months and maintenance records for 60 <br /> months . <br /> \P' 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 /> 2 Y�A S 51 Y\ o w c xy a wLtk (th 1-A N C 1 , <br /> Page 3 of 4 <br /> Rev. 9/16/2020 <br /> 1868 E . Hazelton Avenue i Stockton , California 95205 1 T 209 468-3420 i F 209 464-0138 I www . sjgov . org/EHD <br />