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Environmental Health Department <br /> SAN JOAQUINk <br /> Corrective Action Statement <br /> RE : September 20 , 2019 , 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 /> Submit completed form to: <br /> Facility name: LODI MUNI SERVICE CENTER SJC ENVIRONMENTAL HEALTH t <br /> Facility address: 1331 S HAM LN DEPARTMENT <br /> ATTN : SHEWIT WOLDEAREGAY <br /> CERS ID: 10181549 1868 E HAZELTON AVENUE <br /> PR0231332 <br /> Violation #118 - Failure to submit the "Underground Storage Tank Statement of Understanding and <br /> Compliance Form" . 1 <br /> JAo This violation was corrected El This violation will be corrected by (date) : <br /> Supporting documents included, <br /> Describe actions taken or will be taken to correct violation: o mid 1! � q�j �o C=zt p, Ll I TAM& 0 <br /> Violation #124 " "Overfill Prevention Equipment Inspection Report Form" not submitted within 30 days of i <br /> inspection. <br /> r <br /> )---This violation was corrected ❑ This violation will be corrected by (date) : <br /> Supporting documents included <br /> `i <br /> Describe actions taken or will be taken to correct violation: ' <br /> 43 )( Ille 11 <br /> .j <br /> Page 1 of 2 <br /> I <br /> 1868 E . Hazelton Avenue i Stockton , California 95205 i T 209 468-3420 i F 209 464-0138 i www.sjcehd . com , <br /> % i <br /> i <br /> a <br />