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SAW Q Environmental Health Department <br /> k ----C O U N T Y ., <br /> Gr otr s� �t o3a here, <br /> Corrective Action Statement <br /> RE: February 09, 2021, 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 form <br /> with the Return to Compliance Certification'within 30 days of inspection. If you have any questions,please contact <br /> Stacy Rivera at or sriveraRsigov.orq. <br /> Facility name: WILSON WAY CHEVRON <br /> Submit completed form to: <br /> Facility address: 437 N WILSON WAY SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10180899 ATTN:STACY RIVERA <br /> PRO506406 1868 E HAZELTON AVENUE <br /> STOCKTON,CA 95205 <br /> Violation#118-Failure to submit the"Overfill Prevention Equipment Inspection Report Form"within 30 <br /> days. <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 /> Violation#208-Failure to comply with the,designated operator inspection requirements. <br /> ❑ This violation was corrected ❑This violation will be corrected by(date): �G�� �• ��f�� <br /> ❑ Supporting documents included <br /> Describe actions taken or will be taken to correct violation: (!5 � <br /> f-� 2''42 <br /> 42 <br /> Page 2 of 2 <br /> 1868 aze ton venue oc cton, California 95205 T 209 468-3420 1 F 209 46 1 www.sjcehd.com <br />