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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 Gircotnem 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 /> Facility name: CHEVRON STATION#94275* Submit completed form to: <br /> Facility address: 2905 W BENJAMIN HOLT DR SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10181335 ATTN: LYNSEY SAMMONS <br /> PR0231952 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#7-2010003-Owner/Operator submitted DO form and/or informed the CUPA of any change(s) <br /> within 30 days(TCR 10). <br /> l5a 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: CERS updated on 12/18/2024 <br /> Violation#47-2030008-Secondary containment installed after July 1,2003 is free of water. <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: Work order attached <br /> Page 2 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 />