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,{ <br /> SAN OAQ IJ I N Environmental Health Department <br /> r� r � - <br /> ,.,. C Q U h! T Y ----- - <br /> ' '•� ! / r ' f� reotrless 91. 1111 here <br /> Corrective Action Statement <br /> RE : October 23 , 2019 , 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 . 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 /> Shewit Woldearegay at (209) 468-0216 or stwoldearegayasjgov. org . <br /> Facility name : Arco . Am pm 83333 Submit completed form to : <br /> Facility address : 550 W Valpico Rd SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : 10468777 ATTN : SHEWIT WOLDEAREGAY <br /> PR0536555 1868 E HAZELTON AVENUE <br /> STOCKTON , CA 95205 <br /> Violation #103 - Failure to submit and maintain complete and current financial responsibility documents . <br /> IX, This violation was corrected ❑ This violation will be corrected by ( date) : <br /> ❑ Supporting documents included <br /> k <br /> Describe actions taken or will be taken to correct violation : _ �' � �� ` L N <br /> Violation #106 - Failed to have an approved UST response plan . <br /> J L 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 : ��� W 4NW 4 <br /> Violation #124 - " Overfill Prevention Equipment Inspection Report Form" not submitted within 30 days of <br /> inspection . <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 /> Page 2 of 3 <br /> Rev. 8/27/2019 <br /> 1868 E . Hazelton Avenue I Stockton , California 95205 T 209 468-3420 I F 209 464-0138 1 www. sjcehd . com <br />