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r, SIN <br /> ANJ 0 AQ I I Environmental Health Department <br /> COUNTY <br /> Greatness grows here. <br /> Corrective Action Statement <br /> RE: January 25, 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. <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 Kristina Saetern at(209)616-3045 or ksaetern@sjgov.org. <br /> Facility name: TRACY USD-SERVICE CENTER Submit completed form to: <br /> Facility address: 1975 W LOWELL AVE SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10181579 ATTN: KRISTINA SAETERN <br /> PR0232521 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#107-Failure to submit and maintain complete and current financial responsibility documents. <br /> V 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: The financial responsibility documents were uploaded into <br /> CERS and a copy has been placed into the on site binder. <br /> Violation#115-Failure to submit"Monitoring System Certification Form"within 30 days of completion of the <br /> test. <br /> 9 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: We will ensure the Monitoring System Certification Form <br /> of the testing will be submitted to EHD within 30 days. <br /> Violation#209-Failure to maintain a copy of the"Facility Employee Training Certificate"on-site. <br /> V 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: We have updated the Facility Employee Training <br /> Certificate to list the employees hire date and initial training date. <br /> Page 2 of 2 <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 />