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Environmental Health Department <br /> S-ANA-04-U .1 *N : <br /> ( ks . <br /> '` .�Lth�.S��.--•" . . ViFL73tJ#$S5 f� rESWS �P. jv. <br /> Corrective Action Statement <br /> RE: October 09, 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 /> Marks Fuel & Food, Inc., 880 E VICTOR RD, CERS ID: 10181491 , PR0231746 <br /> Violation #113 - Failure to submit "Monitoring System Certification Form" within 30 days of completion of <br /> the test. <br /> SEI 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: , , , iv,1q*k 4.(�[ , a . <br /> Violation 9195 - "Designated Underground Storage Tank Operator Identification Form" not submitted within <br /> 30 days. <br /> qeoo�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 : ::Ej: i (,I Lwx . < )efk je, r l bn <br /> Sr ')fit <br /> Violation #118 - Failure to submit the "Underground Storage Tank Statement of Understanding and <br /> Compliance Form". <br /> 0/0�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: ur_ S cS �'Llrnt�J e C d/1 <br /> c <br /> Page 2 of 5 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />