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SAN J O A Q U I N Environmental Health Department <br /> C0l_JN, TY <br /> Corrective Action Statement <br /> RE : July 22 , 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 form <br /> with the Return to Compliance Certification within 30 days of inspection . If you have any questions , please contact <br /> Shewit Woldearegay at (209) 616-3063 or stwoldearegay@sjgov. org . <br /> Facility name : QUIK STOP MARKET # 144 Submit completed form to : <br /> Facility address : 7272 WEST LN SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : 10180967 ATTN : SHEWIT WOLDEAREGAY <br /> PR0231939 1868 E HAZELTON AVENUE <br /> STOCKTON , CA 95205 <br /> Violation #107 - Failure to submit and maintain complete and current financial responsibility documents . <br /> [2[ 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 /> Current Financial Responsibility documents have been provided to the site and will be maintained <br /> onsite . <br /> Violation #206 - Failure to have a current UST Response Plan available on site . <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 UST Response Plan has been provided to the site and is available for inspection . <br /> Violation #208 - Failure to comply with the designated operator inspection requirements . <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 /> Future designated operator reports will be submitted within the required timeframe and will include all <br /> of the required information . <br /> Page 2 of 2 <br /> Rev. 9/16/2020 <br /> 1868 E . Hazelton Avenue I Stockton , California 952051 T 209 468-3420 1 F 209 464-0138 1 www, sjgov. org/EHD <br />