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Environmental Health lth Department <br /> SAW"JOAm .; .:. UINY <br /> Corrective Action Statement <br /> RE: April 26, 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 John Aianiz at(209)616-3053 or jalanizl @sjgov.org. <br /> Facility name: WOODBRIDGE AM PM* Submit completed form to: <br /> Facility address: 18806 N LOWER SACRAMENTO RD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10181237 ATTN: JOHN ALANIZ <br /> PR02323B8 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#107-Failure to submit and maintain complete and current financial responsibility documents. <br /> ❑ This violation was corrected ❑This violation will be corrected by(date): <br /> ❑ Supporting documents included <br /> De sc 'be actions taken or will be taken to correct violation: I 2 f Z 1 �� � ` ` f} <br /> cp <br /> M V k"V^� m 4 <br /> Violation#205-Failure to have current UST Monitoring Plan readily accessible at the facility. <br /> ❑ This violation was corrected ❑This violation will he corrected by(date): <br /> ❑ Supporting documents included <br /> Describe actions taken or will be taken to correct violation: <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: <br /> 111au 011 TOR CP- <br /> Page 2 of 3 <br /> Rev.911612020 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 I www.sjgov.orglEHD <br />