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Environmental Health Department <br /> SANJOAQUIN <br /> In <br /> COU NTY <br /> Greatness grows here. <br /> Corrective Action Statement <br /> RE: April 27, 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. Also, <br /> describe what was done to correct the violation in the space provided below each violation. Submit this completed <br /> form with the Return to Compliance Certification within 30 days of inspection. If you have any questions, please <br /> contact Frederick Ernest at(209) 616-3026 or fernest@sjgov.org. <br /> Facility name: 7-ELEVEN #38153 Submit completed form to: <br /> Facility address: 121 S CENTER ST SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10770799 ATTN: FREDERICK ERNEST <br /> PR0543446 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#102 - Failure to submit a complete and accurate application for a permit to operate a UST. <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 /> 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 /> 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 /> Page 2 of 4 <br /> Rev.9/16/2020 <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 />