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SAN J D A HI Environmental Health Department <br /> -• —COUNTY-NTY- – <br /> r4.x.. Greatness grows hero. <br /> Corrective Action Statement <br /> RE: August 29, 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 Paul Nso at(209)468-3432 or pnso@sjgov.org. <br /> Submit completed form to: <br /> Facility name: Manteca Valero SJC ENVIRONMENTAL HEALTH <br /> Facility address: 1700 E YOSEMITE AVE DEPARTMENT <br /> CERS ID: 10181431 ATTN: PAUL NSO <br /> 1868 E HAZELTON AVENUE <br /> PR0231454 <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 <br /> Describe actions taken or will be taken to correct violation: <br /> Violation#118 - Failure to submit the "Underground Storage Tank Statement of Understanding and <br /> Compliance Form". <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 /> Page 1 of 2 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />