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S A J O A I Environmental Health Department <br /> '�•'r- —COUNTY <br /> r4.;•. Greatness grows <br /> Corrective Action Statement <br /> RE: June 30, 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 /> Facility name: PACIFIC CAR WASH/MARKETPLACE INC Submit completed form to: <br /> Facility address: 4405 PACIFIC AVE SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10182305 ATTN: PAUL NSO <br /> PR0508452 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#103 - Failure to submit and maintain complete and current financial responsibility documents. <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#111 - Failed to test monitoring and leak detection equipment every 12 months. <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#113 - Failure to submit "Monitoring System Certification Form"within 30 days of completion of the <br /> test. <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 /> Page 2 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 />