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SAN 1 O A Q U I N 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@sigov.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 In 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 : QUE To VoLu tnij 'tdo0 S R. E.GOk" 1 t` m <br /> tAhl" �a�DeR AOT SlIE t 'C 01AIAtu� D P.EL� RIkC Fio�2 . -cWo t: ids ASD 'j.E <br /> ci1S .s1?F <br /> Violation #202 - Failure to maintain the "Facility Employee Training Certificate" onsite (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 /> AG\t-lt `1 E.'�A�Loyt" . S "C{LAt1.11c�iy LE {L'IIFICATE CLR.1ll LAUTAL WeISE <br /> w �'M accukA�'ta til foitrNl A'ttorl C3'� -*s US1 DESI64Aot eEMVIIO L <br /> Violation #204 - Current monitoring plan approved by the EHD not found on site. <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: Cu0A1*jr W'( MO)A1;-1i Kt" PIAN AP. PAMVEO <br /> �y SON WAS L\S?EU U <,IOER "[NiE U1*3bEk&, imm Srb9wA & E ?PrNY.S . 1T <br /> RhS MW TAGGED SEPWA&IEIN IIt 'lyse MAIN SIWOEL FOLDER. <br /> Page 2 of 3 <br /> Rev, 8WI2019 <br /> 1868 E . Hazelton Avenue I Stockton , California 95205 1 T 209 468-3420 F 209 464-0138 1 www.sjcehd . com <br />