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SAN J 0 A Q U I P J Environmental Health Department <br /> Corrective Action Statement <br /> RE: March 12, 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 Shewit Woldearegay at(209)468-0216 or stwoldearegay@sjgov.org. <br /> Facility name: MAIN STREET ARCO AM PM' Submit completed form to: <br /> Facility address: 1100 S MAIN ST SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10182243 ATTN: SHEWIT WOLDEAREGAY <br /> PR0506504 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#201 -Failure to maintain monitoring,maintenance,and follow up action records. <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: [SUE To ALU MLl'u o0 S I&PCok" I t ME <br /> td h VtA- FOLDER Al SITE VT C_O NTA WE-b Q E CD9&( FOO- 'YWO �f F h" AIRD 7HE <br /> 7L\" JFFo'--1)Ef,L �P�1N Ot.fZ� prVRIt.At3LE <br /> ifs ATF. <br /> Violation#202-Failure to maintain the"Facility Employee Training Certificate"on-site(after October 1, <br /> 2018). <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 /> A C.\►-Vt`t E."P'r0-1 tom.S "r1L1S11.1 IN 4 LB O-1 IFI U47E CL UII EL'C1uNS W E ,& <br /> MIkO>~ WXTA Acc.uIL.ME W.fokm AT1orli -AVE US"! iS1614&1E D 09KLKIQQ -- <br /> Violation#204-Current monitoring plan approved by the EHD not found on site. <br /> X 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: CU0.(LEN3 M01.1\TDI,U" PLhIA NSPAJDVED <br /> M F-Z4" WAt L\STEQ UNDER jlrO UNt£EKW o0'D STo LA&E "TRNKS. IT <br /> FIRS PEEN TAC.6EDSEPKAA-TF-l.`1 w -Tyke MAIN 1;�1Ntm FOLDEfR <br /> Page 2 of 3 <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 />