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SAN 10AQUIN Environmental Health Department <br /> C i.. N ` Y <br /> Corrective Action Statement <br /> RE: April 06, 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 stwoIdearegay@sjgov.org. <br /> Facility name: ARCO AM/PM#83831" Submit completed form to: <br /> Facility address: 1904 DANIELS ST SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10761034 ATTN: SHEWIT WOLDEAREGAY <br /> PR0541937 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#208-Failure to comply with the designated operator inspection requirements. <br /> fit 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: �� .t �j f� ir) 6'v1 �— <br /> k (-.V <br /> 1►) .� R,I /�-� D 1�, hb�.� fi"`►�.� � 1 , <br /> nI�S <br /> Violation#209-Failure to maintain a copy of the"Facility Employee Training Certificate"on-site. <br /> ❑ 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: �Irj�A It ?'q C!�/�► <br /> 014 <br /> Rev.9/16/2020 Page 2 of 2 <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 />