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SAN J OA Q U I N Environmental Health Department <br /> c 0 u �'% v <br /> Corrective Action Statement <br /> RE : January 17 , 2023 , 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 form <br /> with the Return to Compliance Certification within 30 days of inspection . If you have any questions , please contact <br /> Paul Nso at (209) 616-3049 or pnso@sjgov. org . <br /> Facility name: CHEVRON USA #201761 * Submit completed form to : <br /> Facility address : 1103 S MAIN ST SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : 10181653 ATTN : PAUL NSO <br /> PR0232587 1868 E HAZELTON AVENUE <br /> STOCKTON , CA 95205 <br /> Violation #101 - Failure to obtain a permit to operate from the EHD including but not limited to unpaid <br /> permit fees . <br /> 0 This violation was corrected ❑ This violation will be corrected by (date) : <br /> IR Supporting documents included <br /> Describe actions taken or will be taken to correct violation : Fees paid on 3/8/2023 <br /> Violation #202 - Failure to retain a paper or electronic copy of the permit to operate at the facility . <br /> I� This violation was corrected ❑ This violation will be corrected by (date) : <br /> 6� Supporting documents included <br /> Describe actions taken or will be taken to correct violation : Waiting on permit to be maild from agency <br /> Page 2 of 2 <br /> Rev. 9/16/2020 <br /> 1868 E . Hazelton Avenue I Stockton , California 952051 T 209 468-3420 1 F 209 464-0138 1 www. sjgov. org/EHD <br />