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r <br /> RECEIVED BY EHD VIA EMAIL: <br /> 2/23/2022 <br /> SAN J O A Q U I N Environmental Health Department <br /> Corrective Action Statement <br /> RE-January 26, 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(209)616-3061 or cpresto@sigov org <br /> Faality name. BILLJAR VALERO Submit completed form to: <br /> Facility address: 153 E ELEVENTH ST SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID. 10181331 ATTN:CAROL PRESTO <br /> PR0231389 1868 E HAZELTON AVENUE <br /> STOCKTON,CA 95205 <br /> Violation#107-Failure to submit and maintain complete and current financial responsibility documents. <br /> 0 This violation was corrected ❑This violation will be corrected by(date): <br /> ❑ Supporting documents included <br /> Descnbe actions taken or will be taken to correct violation. Mp5 C(, C. c it L 1 <br /> Violation#115-Failure to submit"Monitoring System Certification Form"within 30 days of completion of the <br /> test <br /> R1 This violation was corrected ❑This violation will be corrected by(date): <br /> Id Supporting documents included <br /> Describe actions taken or will be taken to correct violation Te S� \rr 5 w I S O VN S\� <br /> Violation#116-Failure to submit the"Spill Container Testing Report Form"within 30 days. <br /> Z This violation was corrected ❑This violation will be corrected by(date): <br /> Ef Supporting documents included <br /> Describe actions taken or will be taken to correct violation: I&Sk' V,--S G <br /> �L. ems. <br /> Page 2 of 4 <br /> n..wiw= <br /> 1668 E Hazelton Avenue i StoO..ton California 952051 T 209 468.34201 F 209 464-0138 1 www slgov orglEHD <br />