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r, SIN <br /> ANJ 0 AQ I I Environmental Health Department <br /> COUNTY <br /> Greatness grows here. <br /> Corrective Action Statement <br /> RE: August 16, 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: PACIFIC AVE Submit completed form to: <br /> Facility address: 6131 PACIFIC AVE SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10180905 ATTN: SHEWIT WOLDEAREGAY <br /> PR0231223 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#101 -Failure to obtain a permit to operate from the EHD including but not limited to unpaid permit <br /> fees. <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: UST Permit Obtained and is active through <br /> 12/31/23. All Outstanding fees have been paid to San Joaquin County EHD including any <br /> past due fees related to previous outstanding violations. <br /> Violation#107-Failure to submit and maintain complete and current financial responsibility documents. <br /> 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: A electronic copy was made available onsite <br /> to the inspector on the site's tablet. The folder labled "CERS documents" contained a copy of the <br /> certification of financial responsibility, however a separate folder called "Certification of Financial <br /> Responsibility will be created for ease of access to these documents in the future. <br /> Page 2 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 />