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SAN J O A Q U I N Environmental Health Department <br /> � CIJ1\1TY <br /> Corrective Action Statement <br /> RE : March 03 , 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. Also , <br /> describe what was done to correct the violation in the space provided below each violation . Submit this completed form <br /> with the Return to Compliance Certification within 30 days of inspection . If you have any questions , please contact <br /> Shewit Woldeareqay at ( 209 ) 468 -0216 or stwoldearegay cpsigov. orq . <br /> Facility name : AGS FUEL INC DBA CIRCLE K CHEVRON Submit completed form to: <br /> Facility address : 1490 S MAIN ST SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : 10785304 ATTN : SHEWIT WOLDEAREGAY <br /> PR0541436 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 14This violation will be corrected by (date) : /tQap rjy�, 3 � S �o <br /> Supporting documents Included <br /> Describe actions taken or will be taken to correct violation : Al )! 'll �tu AVwOnA <br /> Violation #124 - " Overfill Prevention Equipment Inspection Report Form " not submitted within 30 days of <br /> inspection . <br /> � II This violation was corrected LThis violation will be corrected by (date) : Zt� <br /> Supporting documents included /r <br /> Describe actions taken or will be taken to correct violation : /211 A it l,t ,2i( <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) : ] C L� D � w) C t d <br /> Supporting documents Included <br /> Describe actions taken or will be taken to correct violation : + ' <br /> (24 AAA QL 1AjQ <br /> p p,,,v elk �, z , � � �i , S op h <br /> Rev. 8mi20 + 9 - Page 2 of 4 <br /> 1868 E . Hazelton Avenue Stockton , California 95205 1 T 209 4611 F 209 464- 0138 i www. sjcehd . com <br />