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tF Environmental Health Department <br /> SAN 10AQUIN <br /> COUNTY <br /> / <br /> �i�,Fnpa`P' Greatness grows he <br /> Corrective Action Statement <br /> RE : July 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 . <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 /> STOP N SHOP , 1856 W COUNTRY CLUB BLVD , CERS ID : 10180831 , PR0231069 <br /> Violation #109 - Failure to submit " Designated Underground Storage Tank Operator Identification Form" <br /> within 30 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 : 7+w <br /> d <br /> � O <br /> F <br /> Violation # 110 - Failure to submit the " Underground Storage Tank Statement of Understanding - <br /> Compliance Form " . <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 #112 - Failure to have properly qualified service technician test leak detection equipment every 12 <br /> months . <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 /> Page 4 of 6 <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 />