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SAN J O A Q U I N Environmental Health Department <br /> COUNTY <br /> i / �F,;;<.; Greo . ness yroars here . <br /> Corrective Action Statement <br /> RE : August 10 , 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 Woldearegay at (209) 468-0216 or stwoIdearegay@sigov. org . <br /> Facility name : QUIK STOP MARKET #3138 Submit completed form to: <br /> Facility address : 1153 LINCOLN BLVD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : 10181059 ATTN : SHEWIT WOLDEAREGAY <br /> PR0231413 1868 E HAZELTON AVENUE <br /> STOCKTON , CA 95205 <br /> Violation #103 - Failure to submit and maintain complete and current financial responsibility documents . <br /> CX 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 /> Financial responsibility documents have been provided to DO to maintain onsite . <br /> Violation #204 - Current monitoring plan approved by the EHD not found on site . <br /> IN 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 /> Monitoring Plan has been provided to DO to maintain onsite . <br /> 05 - Failure to submit a current UST Response Plan and have it available onsite . <br /> Violation #2 p <br /> [I 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 /> The UST Response Plan has been provided to DO to maintain onsite . <br /> Page 2 of 3 <br /> Rev. 8/27/2019 <br /> 2 464-0138 www. sjcehd . com <br /> 1868 E . Hazelton Avenue Stockton , California 95205 I T 209 468 3420 I F 09 I www. sjcehd . com <br />