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SAN 10 A Q U I N Environmental Health Department <br /> Corrective Action Statement <br /> RE: January 20, 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 Lydia Baker at(209)616-3046 or(baker@sjgov.org. <br /> Facility name: PACIFIC AVE CHEVRON Submit completed form to: <br /> Facility address: 6633 PACIFIC AVE SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10594654 ATTN: LYDIA BAKER <br /> PR0231784 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#107-Failure to submit and maintain complete and current financial responsibility documents. <br /> �J <br /> ❑ This violation was corrected 19/This violation will be corrected by(date): <br /> supporting documents included <br /> Describe actions taken or will be taken to correct violation: <br /> Violation#203-Failure to maintain monitoring records for 36 months and maintenance records for 60 <br /> months. <br /> ❑ This violation was corrected ®'This violation will be corrected by(date): - <br /> Iv/supporting documents included <br /> Describe actions taken or will be taken to correct violation: <br /> Violation#208-Failure to comply with the designated operator inspection requirements. <br /> kl, his violation was corrected ❑This violation will be corrected by(date): <br /> kJ/supporting documents included <br /> Describe actions taken or will be taken to cor.,rect violation: <br /> C� r) p e. c+t t r) Itii tv5 6t o vj e L/vi <br /> 4-Z� S i e: ✓s -D )Cj s LAI 1` 149 k cs <br /> -t�- <br /> Page 2 of 2 <br /> Rev.9/16/2020 <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 />