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SA I O A Q I � I N Environmental Health Department <br /> .�ja� C 0 U <br /> 4 ICI <br /> .r G,rcotnem Rrow4 hrrr, <br /> Corrective Action Statement <br /> RE: December 16, 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 /> Lynsey Sammons at(209)616-3067 or Isammons@sjgov.org. <br /> CHEVRON STATION #94275*, 2905 W BENJAMIN HOLT DR, CERS ID: 10181335, PR0231952 <br /> Violation#55-2010004-Copies of DO inspections for last 12 months maintained,36 months for those after <br /> 10/1/18(TCR 12). <br /> C9 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: Photo of DO reports attached. <br /> Violation#59-2030001 -Records of release detection monitoring and maintenance properly maintained <br /> (TCR 9d). <br /> ® This violation was corrected ❑This violation will be corrected by(date): <br /> I@ Supporting documents included <br /> Describe actions taken or will be taken to correct violation: 12/18/2021 & 12/27/2024 test results attached. <br /> Page 3 of 3 <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 />