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SAN 10AQUIN Environmental Health Department <br /> COUNTY <br /> Corrective Action Statement <br /> RE: August 16, 2022, 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: Verizon Business:KINGCA Submit completed form to: <br /> Facility address: 13850 N DE VRIES RD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10181479 ATTN:STACY RIVERA <br /> PR0231547 1868 E HAZELTON AVENUE <br /> STOCKTON,CA 95205 <br /> Violation#202-Failure to retain a paper or electronic copy of the permit to operate at the facility. <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 /> f4,:,�aZ �2 <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 /> Page 2 of 2 <br /> Rev.911&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 />