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SA N �� IIIN Environmental Health Department <br /> -COUNTY <br /> Greotness grows here. <br /> r�. <br /> Corrective Action Statement <br /> RE: July 28, 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 /> Harney Lane 76, 141 E HARNEY LN, CERS ID: 10844113, PR0543574 <br /> Violation#115-Failure to submit"Monitoring System Certification Form"within 30 days of completion of the <br /> test. <br /> 911 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: Test report submitted late. Reminder to facility to pay <br /> monitoring company in timely manner in order to submit results within 30 days. <br /> Violation#116-Failure to submit the"Spill Container Testing Report Form"within 30 days. <br /> VThis 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: Test report submitted late. Reminder to facility <br /> and monitoring certification company that results need to be submitted within 30 days. <br /> Violation#122-Failure to implement corrections and submit written response within 30 days of receiving the <br /> report. <br /> 'b° 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: Corrective action noted, reminder to facility <br /> that corrections need to be addressed within 30 days. <br /> Page 3 of 5 <br /> Rev.9/16/2020 <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 />