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SAN J OAQ U I N Environmental Health Department <br /> — COUNTY-- <br /> Greainess orohs here <br /> Corrective Action Statement <br /> RE: June 16, 2025, inspection report <br /> For each violation listed below,indicate if the violation has been corrected or will be corrected by a certain date. Also, <br /> describe what was done to correct the violation in the space provided below each violation. Submit this completed form <br /> with the Retum to Compliance Certification within 30 days of inspection. if you have any questions, please contact <br /> Monica De Anda at(209)616-3063 or mdeanda@sjgov.org. <br /> Facility name: MOUNTAIN HOUSE CHEVRON Submit completed form to: <br /> Facility address: 1124 N INTERNATIONAL PKWY SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10926289 ATTN:MONICA DE ANDA <br /> PR0548106 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation 010-2030074-Annual Monitoring System Certification Form to the CUPA within 30 days of <br /> completion of the test. <br /> >rThis violation was corrected ❑This violation will be corrected by(date): <br /> ❑ Supporting documents included <br /> Describe actions taken or will be taken to correct viol - n: (.ems ;T� 1 C,—~ rI <br /> A�r_ <br /> Violation#13-2010017-Spill bucket testing results submitted to the UPA within 30 days of testing. <br /> 4—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 /> oke-- <br /> Page 2 of 4 <br /> Rev.911612020 <br /> 1868 E. Hazelton Avenue I Stockton,California 95205 1 T 209 46B-3420 I F 209 464-0138 1 wwvw sjgov.org/EHD <br /> ---------------------------- <br /> Scanned with <br /> m CamScanner ;: <br />