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S A N sJ O AQ U I N Environmental Health Department <br /> COUNTY <br /> Corrective Action Statement <br /> RE : August 24 , 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 Gabriela Garcia-Mejia at (209) 616-3037 or ggarcia-mejia@sjgov. org . <br /> Delta arco , 440 W DR MARTIN LUTHER KING JR BLVD , CERS We 10180903 , PR0231055 <br /> Violation #115 - Failure to submit " Monitoring System Certification Form " within 30 days of completion of the <br /> test. <br /> This violation was corrected ❑ This violation will be corrected by ( date) : <br /> ❑ Supporting documents included <br /> t- QM2 <br /> Describe actions taken o will be taken to correct violation : 1Al2" h4ftAll O (�l "� <br /> C4 A 444 re <br /> Violation #116 - Failure to submit the "Spill Container Testing Report Form" within 30 days . <br /> ,lel. 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 : i (� &4.&4 - ,l+7' A'� � %�e <br /> Violation #117 - Failed to submit "Secondary Containment Testing Report Form" within 30 days after the test. <br /> .4 This violation was corrected ❑ This violation will be corrected by (date) : <br /> ❑ Supporting documents included 1 <br /> Describe actions taken or will be t ken to correct violation : J"k f f1 h1t <br /> 7A qLAA <br /> Page 3 of 4 <br /> Rev. 9/16/2020 <br /> 1868 E . Hazelton Avenue ( Stockton , California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www. sjgov . org/EHD <br />