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SAN JOAQU`N Environmental Health Department <br /> C0tJNTY <br /> Corrective Action Statement <br /> RE: January 28, 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. Also, <br /> describe what was done to correct the violation in the space provided below each violation. Submit this completed <br /> form with the Return to Compliance Certification within 30 days of inspection. If you have any questions,please <br /> contact Eiianna Flondo at(209)616-3050 or efloddo@sjgov,org. <br /> COUNTRY CLUB MOBIL CIRCLE K, 2575 COUNTRY CLUB BLVD,CERS ID: 10118074, PR023 <br /> Violation#112-Failure to have properly qualified service technician test leak detection equipment every 12 <br /> months. <br /> 17 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: w&S, v N <br /> Violation#115-Failure to submit"Monitoring System Certification Form"within 30 days of completion of the <br /> test. <br /> 651"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: -Tg S-, <br /> ),Cts. <br /> Violation#116-Failure to submit the"Spill Container Testing Report Form"within 30 days. <br /> Id 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 3 of 6 <br /> Rev.WIEW20 <br /> 1868 E. Hazelton Avenue 1 Stockton, CalOornia 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org1EHD <br />