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A Environmental Health Department <br /> C <br /> f lid Y <br /> Corrective Action Statement <br /> RE: January 05, 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 Kristina Saetem at(209)616-3045 or ksaetern@sjgov,org. <br /> Facility name: VAN DE POL ENTERPRISES INC Submit completed form to: <br /> Facility address: 816 E FRONTAGE RD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10181513 ATTN: KRISTINA SAETERN <br /> PR0231470 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 /> e <br /> 6"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: h-6 hear, p1A.t_i tL i <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 /> B'--Supporting documents Included <br /> Describe actions taken or will be taken to correct violation: —DX, m4e A-A (Lrr CLf1 A-fA r( <br /> u0C4 yrs►k. <br /> Rev,911 61202C Page 2 of 2 <br /> 1868 E, Hazelton Avenue I Stockton, California 952061 T 209 468-3420 1 F 209 464-0138 1 www.sigov.org/EHD <br />