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SAN JOAQUIN <br />COUNTY <br />Environmental Health Department <br />Corrective Action Statement <br />RE: August 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 Vicky Vang-Lee at (209) 616-3028 or vvang-lee@sjgov.org. <br />Facility name: MIRACLE MILE MARKET Submit completed form to: <br />Facility address: 244 W HARDING WAY SJC ENVIRONMENTAL HEALTH DEPARTMENT <br />CERS ID: 10180779 ATTN: VICKY VANG-LEE <br />PR0231137 1868 E HAZELTON AVENUE <br />STOCKTON, CA 95205 <br />Violation #115 - Failure to submit "Monitoring System Certification Form" within 30 days of completion of the <br />test. <br />❑ This violation was corrected 0-Thisviolation will be corrected by (date): <br />❑ Supporting documents included <br />Describe actions taken or will be taken to correct violation: kl/ <br />Violation #116 - Failure to submit the "Spill Container Testing Report Form" within 30 days. <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: 1- V CV i•/) � I ue S . _ •�.� ` r u (3i9- <br />/ <br />Violation #208 - Failure to comply with the designated operator inspection requirements. <br />❑ This violation was corrected CPil—is violation will be corrected by (date): o , <br />❑ Supporting documents included <br />Describe actions taken or will be taken to correct violation: <br />I' *Y --.J' cD x <br />Page 2 of 2 <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 />