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SAN I Environmental HealthDepartment <br /> Corrective Action Statement <br /> RE: November 13, 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. 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 Carol Presto at(209)616-3061 or cpresto@sjgov.org. <br /> Facility name: KISHIDA, GEORGE INC Submit completed form to: <br /> Facility address: 1725 ACKERMAN DR SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10181383 ATTN: CAROL PRESTO <br /> 1868 E HAZELTON AVENUE <br /> PR0231309 STOCKTON, CA 95205 <br /> Violation#115-Failure to submit"Monitoring System Certification Form"within 30 days of completion of the <br /> test. <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: W11/� Gir{2SW✓� �� �`'t�`'�rK�1� �" <br /> Violation#122-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 /> W Supporting documents included <br /> Describe actions taken or will be taken to correct violation: "W+--.SlA- <br /> L ',1l41 . <br /> Page 2 of 3 <br /> rtev.911612020 <br /> 1868 E_ Hazelton Avenue i Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www,sigov.org/EHD <br />