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SANJOAQUIN Environmental Health Department <br /> Y - <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 : LODI OIL INC ARCO #83680 Submit completed form to : <br /> Facility address : 14931 N FLAG CITY BLVD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : 10182237 ATTN: PAUL NSO <br /> PR0506221 1868 E HAZELTON AVENUE <br /> STOCKTON , CA 95205 <br /> Violation #103 - Failure to submit and maintain complete and current financial responsibility documents . <br /> ti <br /> Ll This violation was corrected 11This 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 /> U This violation was corrected 11This violation will be corrected by (date ) : <br /> ❑ Supporting documents included <br /> Describe actions taken or will be taken to correct violation : 1 ' <br /> Violation #115 - " Designated Underground Storage Tank Operator Identification Form " not submitted within <br /> 30 days . <br /> R, This violation was corrected ❑ This violation will be corrected by ( date ) : <br /> id 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 F 209 464-0138 1 www . sjcehd . com <br />