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Environmental ealth , Department <br /> SAN , JOAQUI � <br /> _.._._.: C Q U N T Y - . ._...- I i ili l ` <br /> Corrective Action Statement <br /> RE: September 27, 2019, Underground Storage Tank inspepxjanire.Ppt r p r <br /> For each violation listed below, indicate if the violation has been corrected or will be corrected by a; certa p; date; Also, <br /> describe what was done to correct the violation in the space provided below each violation . Submit this completed <br /> form with the Return to Compliance Certification within 30 days of inspection . If you have any questions , please <br /> contact Paul Nso at (209) 468-3432 or pnso@sjgov. org. <br /> Facility name: WEST LANE CHEVRON Submit completed form to: <br /> Facility address : 4747 WEST LN SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : 10181343 ATTN: PAUL NSO <br /> 1868 E HAZELTON AVENUE <br /> PR0232482 STOCKTON , CA 95205 <br /> Violation #118 - Failure to submit the " Underground Storage Tank Statement of Understanding and <br /> Compliance Form". <br /> @'iaThis violation was corrected ❑ This violation will be corrected by (date ) : <br /> ❑ Supporting documents included <br /> Describe actions taken or will be takeWtorrect, violation : .L yjGiue CtJ�CG��7� s <br /> � . U i % O / y <br /> V <br /> l <br /> O � r <br /> �-" <br /> Violation #209 - Failure to conduct the designated UST operator visual inspection at least once every 30 <br /> days. / <br /> w This violation was corrected D This violation will be corrected by (date) . <br /> ❑ Supporting documents included <br /> Describe actions taken or will be taken to correct violation: ;/;&f /4;� ��rA? i � <br /> e <br /> G <br /> Page 2 of 2 <br /> Rev. 812712019 <br /> 1868 E . Hazelton Avenue I Stockton , California 95205 1 T 209 468 -3420 1 F 209 464-0138 1 www. sjcehd . com <br />