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I Environmental fart nent <br /> SAN ] OAQUvr <br /> 0 ! Nil <br /> Corrective Action Statement /VV/ OA0414 RE : November 04, 2019 , Underground Storage Tank Inspection � <br /> For each violation listed below, indicate if the violation has been corrected or will be corrected by a cert i lh e. <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 : CHARTER WAY SHELL* Submit completed form to: <br /> Facility address : 620 W DR MARTIN LUTHER KING JR BLVD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : 10181363 ATTN: PAUL NSO <br /> PR0231058 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 IVt <br /> Describe actions taken or will be taken to correct violation : Co M / e � <br /> ac . <br /> LZ <br /> Violation #105 - Failed to have an approved UST monitoring plan . <br /> Cg`*4�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 /> t� Lbs U .& T a <br /> Violation #107 - Plot plan/site map not submitted or failed to completely show where monitoring is <br /> performed . <br /> Mone This violation was corrected ❑ This violation will be corrected by (date) : <br /> ❑ Supporting documents included <br /> Describe actions taken or will b taken to correct violation : <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 />