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Environmental Health Department <br /> C Eur N T Y- <br /> Corrective Action Statement <br /> RE: January 22, 2020, 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. <br /> Also,describe what was done to correct the violation in the space provided below each violation. Submit this <br /> completed form with the Return to Compliance Certification within 30 days of inspection. If you have any questions, <br /> please contact Paul Nso at(209)468-3432 or pnso@sjgov.org. <br /> ARCO STATION #83560', 2908 W BENJAMIN HOLT DR, CERS ID: 10181253, PR0231021 <br /> Violation#118-Failure to submit the "Underground Storage Tank Statement of Understanding and <br /> Compliance Form". <br /> ,, ' This violation was corrected ❑ This violation will be corrected by(date): <br /> ❑ Supporting documents included ,° r�,,,, t� <br /> Describe actions taken or will be taken to correct violation: �.�V�- -A i i►(k IV <br /> 1'rt 1 "CLQ- D E p_S 601/"Oir-- oul APA& Ti�� <br /> Violation#121 -Failure to implement corrections and submit written response within 30 days of receiving the <br /> report. <br /> ,,O'This violation was corrected ❑This violation will be corrected by(date): <br /> ❑ Supporting documents included -y,,,,, <br /> Describe actions taken or will be taken to correct violation: <br /> Violation#124-"Overfill Prevention Equipment Inspection Report Form" not submitted within 30 days of <br /> inspection. <br /> , '*'This violation was corrected ❑This violation will be corrected by(date): <br /> ❑ Supporting documents included <br /> Describe actions taken or will betaken to correct violation: &AV9W10=&A � <br /> QX i9m r HCA tT) t.jj ec-> <br /> Page 3 of 4 <br /> Rev.8/27/2019 <br /> 1868 E. Hazelton Avenue i Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />