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SAN 10 A Q U I N Environmental Health Department <br />COUNTY <br />Greotness grows h.^re, <br />Corrective Action Statement <br />RE: January 19, 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. <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 Shewit Woldearegay at (209) 616-3063 or stwoldearegay@sjgov.org. <br />Facility name: TRACY USD - SERVICE CENTER Submit completed form to: <br />Facility address: 1975 W LOVVELL AVE SJC ENVIRONMENTAL HEALTH DEPARTMENT <br />CERS ID: 10181579 ATTN: SHEWIT WOLDEAREGAY <br />PR0232521 1868 E HAZELTON AVENUE <br />STOCKTON, CA 95205 <br />Violation #110 -Failure to submit the "Underground Storage Tank Statement of Understanding and <br />Compliance Form". <br />131 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 Underground Storage Tank Statement of Understanding <br />has been updated and loaded into CERS <br />Violation #208 - Failure to comply with the designated operator inspection requirements. <br />131 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 dates on the designated operator monthly <br />inspection forms have been corrected and will double check test dates in the future <br />Page 2 of 2 <br />Rev. 9116/2020 <br />1868 E. Hazelton Avenue j Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />