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SAN J OAQ U I N Environmental Health Department <br /> COUNTY <br /> Gr )tatness 9rcrrs hers' , <br /> Corrective Action Statement <br /> RE : July 01 , 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 Stacy Rivera at (209) 616-3043 or srivera@sjgov. org . <br /> Facility name : QUIK STOP MARKET #076 Submit completed form to : <br /> Facility address : 1030 S OLIVE AVE SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : 10180695 ATTN : STACY RIVERA <br /> PR0231704 1868 E HAZELTON AVENUE <br /> STOCKTON , CA 95205 <br /> Violation #107 - Failure to submit and maintain complete and current financial responsibility documents . <br /> IN 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 current Financial Responsibility (FR) documents were sent to the site on 7/01 /2021 . In the future the <br /> current FR documents will be maintained onsite in a binder. <br /> Violation #202 - Failure to retain a paper or electronic copy of the permit to operate at the facility . <br /> C$ 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 current Permit to Operate was sent to site on 7/01 /2021 and will maintained on site available for <br /> review. <br /> Violation #206 - Failure to have a current UST Response Plan available on site . <br /> CX 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 current UST Response Plan was sent to the site on 7/02/2021 . In the future the current UST Response <br /> Plan will be maintained onsite and available for review. <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 />