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S A N J n A M N Environmental Health Department <br /> Corrective Action Statement <br /> RE: September 10, 2024, 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 Return to Compliance Certification within 30 days of inspection. If you have any questions, please contact <br /> l..ynsey Sammons at(209)616-3067 or Isammons@sjgov.org. <br /> ST JOSEPHS HOSPITAL, 1800 N CALIFORNIA ST,CERS ID: 10181391, PR0231036 <br /> Violation#8-2010016-"Underground Storage Tank Statement of Understanding and Compliance Form" <br /> submitted(TCR 10). <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: <br /> Violation#53-2010007-Submitted/maintained current Cert of Financial Responsibilitylmech of financial <br /> assurance(TCR 11). <br /> [H' This violation was corrected ❑This violation will be corrected by(date): <br /> ❑ Supporting documents included -t+1r c n,, <br /> Describe actions taken or will be taken to correct violation: ( l���C �Cw ��(�`S <br /> Violation#59-2030001 -Records of release detection monitoring and maintenance properly maintained <br /> (TCR 9d). <br /> I/This violation was corrected ❑This violation will be corrected by(date): <br /> ❑ Supporting documents included c,p ` f r, n <br /> Describe actions taken or will be taken to correct violation: c5/-016L W (n4 us-C. wr4o 6 - <br /> AND (246t SCDC cr--A S 11�11 gC--3 (;)r j <br /> 7E� f'U Cllar( 10 i2 0j06AA7ZCA, <br /> Page 3 of 3 <br /> Rev.911612020 <br /> 1868 E. Hazelton Avenue i Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sjgov.orgiEHD <br />