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�l ►I��aAl I I N Environmental Health Department <br /> L-'r.`' j C:O U N T Y <br /> r o- Greotness grows here. <br /> Corrective Action Statement <br /> RE: September 23, 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. <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 Vicky Vanq-Lee at or. <br /> Facility name: 7-ELEVEN INC#17334 Submit completed form to: <br /> Facility address: 4501 N PERSHING AVE SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10165815 ATTN:VICKY VANG-LEE <br /> PR0231233 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#109-Failed to test secondary containment,or failed to maintain test records for 36 months. <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#121 -Failure to implement corrections and submit written response within 30 days of receiving the <br /> report. <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#215-Failure to retain a copy of the permit to operate at the facility. <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 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 />