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(�A <br /> SAN 10 A Q U I N Environmental Health Department <br /> C (D U N ' r 'YGreotnes. s grows here <br /> Corrective Action Statement <br /> RE : August 21 , 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 : Verizon Business : KINGCA SJC ENVIRONMENTAL HEALTH <br /> Facility address : 13850 N DE VRIES RD DEPARTMENT <br /> CERS ID : 10181479 ATTN : SHEWIT WOLDEAREGAY <br /> 1868 E HAZELTON AVENUE <br /> PR0231547 <br /> Violation #209 - Failure to conduct the designated UST operator visual Inspection at least once every 30 <br /> days . <br /> WIThis violation was corrected This violation will be corrected by (date) : <br /> F Supporting documents Included <br /> Describe actions taken r will be take to correct violation :rl <br /> !� <br /> Violation #215 - Failure to retain a copy of the permit to operate at the facility. <br /> This violation was corrected his violation will be corrected by (date) : <br /> I 6010A <br /> Supporting documents Included <br /> Describe actions taken or will be taken to correct iolation : <br /> - r o <br /> Page 1 of 1 <br /> 1868 E . Hazelton Avenue Stockton , California 95205 1 T 209 468-3420 1 F 209 464 -0138 4 www . sjcehd . com <br />