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SANIOAQUIN Environmental Health Department <br /> -bA COUNTY <br /> Greatness groves here. <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 /> ® 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 /> 13 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 /> lI 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.9116/2020 <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 />