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UC f 07 221 S N N J O AQ U I (`ENVIRONMENTAL HEALTFinvironmental ruetllur) impartment c 011 N T Y DFPARTMENT ENVIRONMENTAL HEALTH nFPARTMENT Corrective Action Statement RE: September 09, 2021, Underground Storage Tank inspection report For each violation listed below, indicate if the violation has been corrected or will be corrected by a certain date. Also, describe what was done to correct the violation in the space provided below each violation. Submit this completed form with the Return to Compliance Certification within 30 days of inspection. If you have any questions, please contact Carol Presto at (209) 616-3061 or cpresto@sjgov.org. Facility name: Tracy Texaco Submit completed form to: Facility address: 2375 N TRACY BLVD SJC ENVIRONMENTAL HEALTH DEPARTMENT 'ERS ID: 10182109 ATTN: CAROL PRESTO PR0231897 1868 E HAZELTON AVENUE STOCKTON, CA 95205 Violation #107 - Failure to submit and maintain complete and current financial responsibility documents. ❑✓ This violation was corrected ❑ This violation will be corrected by (date): ❑ Supporting documents included Describe actions taken or will be taken to correct violation: Forms have been updated and uploaded to CERS Violation #115 -Failure to submit "Monitoring System Certification Form" within 30 days of completion of the test. ❑✓ This violation was corrected ❑This violation will be corrected by (date): ❑ Supporting documents included Describe actions taken or will be taken to correct violation: Monitoring System Certification has been submitt ed Violation #116 -Failure to submit the "Spill Container Testing Report Form" within 30 days. �✓ This violation was corrected ❑ Supporting documents included ❑ This violation will be corrected by (date): Describe actions taken or will be taken to correct violation: Spill Container Testing Report has been submitted Page 2 of 4 Rev. 9 /1 612 0 2 0 1868 E. Hazelton Avenue � Stockton, California 95205 � T 209 468-3420 � F 209 464-0138 � www.sjgov.org/EHD RECEIVED UC f 07 221 S N N J O AQ U I (`ENVIRONMENTAL HEALTFinvironmental ruetllur) impartment c 011 N T Y DFPARTMENT ENVIRONMENTAL HEALTH nFPARTMENT Corrective Action Statement RE: September 09, 2021, Underground Storage Tank inspection report For each violation listed below, indicate if the violation has been corrected or will be corrected by a certain date. Also, describe what was done to correct the violation in the space provided below each violation. Submit this completed form with the Return to Compliance Certification within 30 days of inspection. If you have any questions, please contact Carol Presto at (209) 616-3061 or cpresto@sjgov.org. Facility name: Tracy Texaco Submit completed form to: Facility address: 2375 N TRACY BLVD SJC ENVIRONMENTAL HEALTH DEPARTMENT 'ERS ID: 10182109 ATTN: CAROL PRESTO PR0231897 1868 E HAZELTON AVENUE STOCKTON, CA 95205 Violation #107 - Failure to submit and maintain complete and current financial responsibility documents. ❑✓ This violation was corrected ❑ This violation will be corrected by (date): ❑ Supporting documents included Describe actions taken or will be taken to correct violation: Forms have been updated and uploaded to CERS Violation #115 -Failure to submit "Monitoring System Certification Form" within 30 days of completion of the test. ❑✓ This violation was corrected ❑This violation will be corrected by (date): ❑ Supporting documents included Describe actions taken or will be taken to correct violation: Monitoring System Certification has been submitt ed Violation #116 -Failure to submit the "Spill Container Testing Report Form" within 30 days. �✓ This violation was corrected ❑ Supporting documents included ❑ This violation will be corrected by (date): Describe actions taken or will be taken to correct violation: Spill Container Testing Report has been submitted Page 2 of 4 Rev. 9 /1 612 0 2 0 1868 E. Hazelton Avenue � Stockton, California 95205 � T 209 468-3420 � F 209 464-0138 � www.sjgov.org/EHD