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SAN �� IIIN Environmental Health Department <br /> -COUNTY <br /> Greotness grows here. <br /> r. <br /> Corrective Action Statement <br /> RE: June 08, 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: QUIK STOP MARKET#152 Submit completed form to: <br /> Facility address: 1721 S CHEROKEE LN# 1 SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10180631 ATTN:VICKY VANG-LEE <br /> PR0232355 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#107-Failure to submit and maintain complete and current financial responsibility documents. <br /> 1Y, 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 /> The financial responsibility documents were provided to site and will be kept in an onsite binder. <br /> Violation#202-Failure to retain a paper or electronic copy of the permit to operate at the facility. <br /> CN 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 /> The operating permit was provided to site and will be retained onsite, as required. <br /> Violation#203-Failure to maintain monitoring records for 36 months and maintenance records for 60 <br /> months. <br /> IX This violation was corrected ❑This violation will be corrected by(date): <br /> Cf Supporting documents included <br /> Describe actions taken or will be taken to correct violation: <br /> The SCT for 4/23/2021 was provided to site and will be kept in an onsite binder. The SCT has been <br /> provided to the EHD. <br /> Page 2 of 3 <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 />