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FEB / 25/ 2022 / FRI 04106 PIS Tracy Truck Stop FAX No , 209832 2312 P , 007 <br /> >, ! O <br /> Envir <br /> t t <br /> nman <br /> Health <br /> e <br /> D t <br /> ' . . mow/ <br /> rtmen <br /> ■ <br /> r,. <br /> Corrective Action Statement <br /> RE : February 22 , 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 Carol presto at (208) 616-3061 or cpresto@sjgov, org . <br /> Facility name_ Tracy Blvd Chevron Submit completed form to: <br /> Faclllty address: 3775 N TRACY BLVD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS 113 : 10181337 ATTN : CAROL PRESTO <br /> PR0231418 1868 E HAZELTON AVENUE <br /> STOCKTON , CA 95205 <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 ; Z <br /> Violation #115 - Failure to submit "Monitoring System Certification Form" within 30 days of completion of the <br /> leaf. <br /> t( 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 /> '� l vh me WILE <br /> . . L QAK C, L.P IA Co 9 lat w olid <br /> Page 2 of 3 <br /> Rev, 9/18/2020 <br /> Received T i m e *- F e b , 2 5 . �' 2 0 2 2' 1 4 . 0 4 P M. ' N o , ] 11495205 I T 209 468-3420 I F 209 4640138 ( wwwsJgov, org/EHD <br />