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SAN 10 A Q U I N Environmental Health Department <br /> Corrective Action Statement <br /> RE: May 08, 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: MORADA CHEVRON FAST N EASY#60" Submit completed form to: <br /> Facility address: 10878 N HWY 99 SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10180717 ATTN:SHEWIT WOLDEAREGAY <br /> PR0231598 1868 E HAZELTON AVENUE <br /> STOCKTON,CA 95205 <br /> Violation#112-Failure to have properly qualified service technician test leak detection equipment every 12 <br /> months. <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: <br /> v"J'2 <br /> Violation#122-Failure to implement corrections and submit written response within 30 days of receiving the <br /> report. <br /> Er v 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: e . e , <br /> w <br /> Rev.9116/2020 Page 2 of 3 <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 />