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SAN JOAQ 1IN Environmental Health Department <br /> f c )I iN I Y <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 boon corrected or will be corrected by a certain data. Also, <br /> descnbe 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 Elianna Florido at(209)61e-3050 or eflondo@sjgov.org. <br /> COUNTRY CLUB MOBIL CIRCLE K,2575 COUNTRY CLUB BLVD,CERS ID: 10118074, PR023 <br /> Violation#118-Failure to submit the"Overfill Prevention Equipment inspection Report Form"within 30 days. <br /> 1!3� This violation was corrected 13 This violation will be corrected by(date): <br /> ❑ Supporting documents included <br /> Describe actions taken or will be taken to correct violation: Ct"-C?z--4' <br /> Violation#202-Failure to retain a paper or electronic copy of the permit to operate at the facility. <br /> d7 This violation was corrected E3 This violation will be corrected by(date): <br /> ❑ Supporting documents included <br /> Describe actions taken or will be taken to correct violation. S VAN, (fo�I►.cc�[S <br /> Arwk-t64 US Of- <br /> Violation <br /> rViolatioon#205-Failure to have current UST Monitoring Plan readily accessible at the facility. <br /> is This violation was corrected ©This violation will be corrected by(date): <br /> 0 Supporting documents included <br /> Describe actions taken or will be taken to correct violation: 1 1� r � C, <br /> Page 4 of 6 <br /> Rev 91&W20 <br /> 1868 E.Hazelton Avenue � Stockton,California 95205 1 T 209 468-3420 1 F 209 464-0138 www.s}gov.orglEHO <br />