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SAN <br /> H'til J OAQ U( N Environmental Health Department <br /> CI OU N TY-_-- <br /> Greotness grows here. <br /> Corrective Action Statement <br /> RE: May 26, 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 Lydia Baker at(209)616-3046 or(baker@sjgov.org. <br /> Facility name: MORADA CHEVRON FAST N EASY#60` Submit completed form to: <br /> Facility address: 10878 N HWY 99 SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10180717 ATTN: LYDIA BAKER <br /> PR0231598 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#104-Failure to have an approved UST Monitoring Plan. <br /> ❑ This violation was corrected 0 This violation will be corrected by(date): <br /> ❑ Supporting documents included <br /> Describe actions taken or will be taken to correct violation: <br /> 11 <br /> �j-W4 , <br /> Violation#106-Failure to submit and maintain a current facility plot plan/site map. <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: 1��� n e c,f� 'lyzp e,1, A_ <br /> Violation#112-Failure to have properly qualified service technician test leak detection equipment every 12 <br /> months. <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: ti� �} <br /> 6. <br /> Page 2 of 5 <br /> Rev.9/1612020 <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 />