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II <br />Envlrcnmental Health Department <br />Corrective Action Statement <br />RE: May 18,2021, Underground storage Tank inspectiorr 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 thiscompleted form with the Return to Compliance Certifrcation within 30 days of inspection. lf yor.r have any questions, <br />please contact John Alaniz at (209) 616-3053 or jalanizl@sjgov.org. <br />'" i- '.i:l L,. trd "f ''f <br />ll,',riiliiri, i'li"r' <br />Facility name: SMK CHEVRON <br />Facility address: 25651 N HWY 99 <br />CERS lD: 10181469 <br />PR0231 628 <br />Submit completed form to: <br />SJC ENVIRONMENTAL HEALTH DEPARTMENT <br />ATTN: JOHN ALANIIZ <br />1868 E HAZELTONI AVENUE <br />STOCKTON, CA 95205 <br />Y <br />Violation #1 18 - Failure to submit the "overfitl Prevention Equipment Inspection Report Form., within 30 days. <br />This violation was corrected E This violation will be corrected by (date): <br />tr Supporting documents included <br />correct <br />{b <br />Violation #304 - Failure to construct, operate, and maintain primary containment as produr:t-tight, <br />F-ffli" violation was corrected <br />tr Supporting documents included <br />S.trt) <br />+- Ettb BV <br />Violation #208 - Failure to c6mply <br />! fnis violation was corrected <br />tr Supporting documents included <br />Describe actions taken or will be taken to <br />Describe actions taken er will be taken to <br />n <br />ft1AlL <br />wz /4s.71,4s <br />€ *fnc-re9 U)oUc-- <br />vr^6lL 12vpre^-A.,,t u A< Olonu <br />op 2a/ I teA< <br />)F Nof <br />ov <br />frt on sl >z'fzozt . <br />the designated operator inspection requirements. <br />E this violation will be corrected by (date): <br />E this violation will be corrected by (date): <br />9/'t6t2020 <br />1B68 E. Hazelion Avenue I <br />Page 2 of 2 <br />stockton, california gS205l r 209468-34201 F 209464-0138 | www.sjgov.org/EHD