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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 /> PACIFIC AVE, 6131 PACIFIC AVE, CERS ID: 10180905, PR0231223 <br /> Violation#115-Failure to submit"Monitoring System Certification Form"within 30 days of completion of the <br /> test. <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: All Violations from UST Inspection on 08/25/22 <br /> have been corrected and closed (see attached documentation). We hired Afforda-Test to complete <br /> our annual testing and they will be sending over copies of the 08/16/23 annual monitoring cert <br /> once available. Afforda-Test is the designated operator as well and will continue to monitor testing compliance <br /> for this site. <br /> Violation#116-Failure to submit the"Spill Container Testing Report Form"within 30 days. <br /> 91 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: Afforda-Test has been hired to complete all required <br /> testing for this site. Upon speaking with them, they informed us that they will continue to be diligent in <br /> sending copies of all reports to the County within the prescribed timeframe. Please see copy of last <br /> Spill Container Report for your records. <br /> Violation#117-Failed to submit"Secondary Containment Testing Report Form"within 30 days after the test. <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: Same plan as above. Please see attached <br /> copy of last secondary containment Testing Report. We will continue to work with Afforda-Test <br /> to make sure that reports are being sent to the County in a more timely manner. <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 />