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RECEIVED 11/19/2021 VIA EMAIL <br /> y0 A 0� Environmental Health Department <br /> Corrective Action Statement <br /> RE: November 18, 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 /> Facility name: KISHIDA, GEORGE INC Submit completed form to: <br /> Facility address: 1725 ACKERMAN DR SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10181383 ATTN:VICKY VANG-LEE <br /> 1868 E HAZELTON AVENUE <br /> PR0231309 STOCKTON, CA 95205 <br /> Violation#104-Failure to have an approved UST Monitoring Plan. <br /> 46- 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#208-Failure to comply with the designated operator inspection requirements. <br /> 49- 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: �� � ttr �< �c.E <br /> J��b >p�.i9-�/fGSIS`Fifl�l�Cr-1y►�1% TlC�i b J�ZFi►�' 1��C�ciC1'� 'Ds��� -AS2 <br /> Violation#306-Failure to remove,analyze,and properly dispose of water in secondary containment(pre-Jul <br /> 2003). <br /> 29- 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: WK;___ L'VyG V-C-,t`A VPVV01e_ <br /> Page 2 of 2 <br /> Rev.9/1612020 <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 />