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Environmental Health Department <br /> SAN �IOAQUIN <br /> - COUNTY <br /> ZI Greotness yro �vs here ) <br /> Corrective Action Statement <br /> RE : May 28 , 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 . 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 stwoldearegay@sjgov. org . <br /> Facility name : MORADA CHEVRON FAST N EASY #60* Submit completed form to : <br /> Facility address : 10878 N HWY 99 SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : 10180717 ATTN : SHEWIT WOLDEAREGAY <br /> PR0231598 1868 E HAZELTON AVENUE <br /> STOCKTON , CA 95205 <br /> Violation # 103 - Failure to submit and maintain complete and current financial responsibility documents . <br /> XThis violation was corrected ❑ This violation will be corrected by ( date) : <br /> ❑ Supporting documents included <br /> i <br /> Describe actions taken or will be taken t correct violation : t �yv �fi � �S 0V4�wc t U 11� 1 <br /> i0x\ Cern 0wwj I A> i nn <br /> 5A �O <br /> Violation #104 - UST operating permit application for facility and tank information not submitted or current. <br /> AThis 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 /> � C evs S <br /> oYve P u e,>r � J <br /> Violation # 105 - Failed to have an approved UST monitoring plan . <br /> l This violation was corrected ❑ This violation will be corrected by ( date) : <br /> / ❑ Supporting documents included <br /> Describe actions taken or will be take tX: vl rrect violation <br /> am V0 r 0/5 1110 K r0lly"erj� <br /> . <br /> Page 2 of 6 <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 />