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�� N Environmental Health Department <br />SAW]Corrective Action Statement <br />RE: May 04, 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 />SMK CHEVRON, 25651 N HWY 99, CERS ID: 10181469, PR0231628 <br />Violation #115 - "Designated Underground Storage Tank Operator Identification Form" not submitted within <br />30 days. <br />* This violation was corrected ❑ This violation will be corrected by (date): <br />❑ Supporting documents included <br />Describe actions taken or v�talS <br />l b e en to corre� t violation. <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 <br />Describe actions taken or will be taken to correct violation: <br />Violation #121 - Failure to implement corrections and submit written response within 30 da 9 the <br />report. <br />❑ This violation was corrected ❑ This violation will be corrected by (d e): <br />❑ Supporting documents included <br />Describe actions taken or will be taken to cAorrrect violation: <br />If� �t]V 1t A r DCQ�i' n <br />t) "D <br />2.c> <br />LO <br />Page 3 of 4 <br />Rev 8/2712019 <br />1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 ,,,' V.sjcehd.com <br />