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S A N J OA Q U I N Environmental Health Department <br /> - tit t <br /> Corrective Action Statement <br /> RE : July 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 . 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 : ORLANDOS Submit completed form to : <br /> Facility address: 18754 E HWY 26 SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : 10182295 ATTN : SHEWIT WOLDEAREGAY <br /> PR0507164 1868 E HAZELTON AVENUE <br /> STOCKTON , CA 95205 <br /> Violation #107 - Failure to submit and maintain complete and current financial responsibility documents . <br /> IU/This violation was corrected ❑ This violation will be corrected by (date) : <br /> ❑ Supporting documents included <br /> Describe actions taken or will bg taken to correct violation : GL �iO� f�Gt4r/rG� l�ls/JG�lSi �/ <br /> D ../ 740 <br /> Violation #203 - Failure to maintain monitoring records for 36 months and maintenance records for 60 <br /> months . <br /> Cly 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 vi ation : �' -J/Uy ;P <br /> �e,4( ' J2 <br /> Violation #208 - Failure to comply with the designated operator inspection requirements . <br /> ❑ This violation was corrected 04hils violation will be corrected by (date) : O 7r <br /> ❑ Supporting documents included <br /> Describe actions taken or will be taken to correct violation : , ZIA 4 L > 0 <br /> APIJOVAJ <br /> Rev. 9/16/2020 Page 2 of 3 <br /> 1868 E . Hazelton Avenue I Stockton , California 95205 1 T 209 468-342.0 1 F 209 464-0138 1 www, sjgov . org/EHD <br />