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S A N J O A n U I N Environmental Health Department <br />Corrective Action Statement <br />RE: January 28, 2021, 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 form <br />with the Return to Compliance Certification within 30 days of inspection. If you have any questions, please contact <br />Carol Presto at (209) 616-3061 or cpresto@sjgov.org. <br />Facility name: <br />BILLJAR VALERO <br />Submit completed form to: <br />Facility address: <br />153 E ELEVENTH ST <br />SJC ENVIRONMENTAL HEALTH DEPARTMENT <br />CERS ID: <br />10181331 <br />ATTN: CAROL PRESTO <br />PR0231389 <br />1868 E HAZELTON AVENUE <br />STOCKTON, CA 95205 <br />Violation #109 - Failure to submit "Designated Underground Storage Tank Operator Identification Form" <br />within 30 days. <br />)71 This violation was corrected 0 This violation will be corrected by (date): <br />Supporting documents Included <br />Describe actions taken or will be taken to correct violation: 0Of¢�r-�11 CA oc� FdJ �^ s.7a5 <br />dt A- <br />Violation #113 - Failure to conduct secondary containment testing. <br />Rf This violation was corrected ❑ This violation will be corrected by (date): <br />,0 Supporting documents included <br />Describe actions taken or will be taken to correct violations:/ 1osIll"r. L4%at do%^e @ a lape., o�whe. <br />li V%Q. <br />per-LAO +[LAO L iWI-- 4 Nnalni C PV'0-v. 1A04J <br />Violation 0117 - Failed to submit "Secondary Containment Testing Report Form" within 30 days after the test. <br />Ray. 0119/ M <br />A This violation was corrected E3 This violation will be corrected by (date): <br />Supporting documents included <br />Describe actions taken or will be taken to correct violation: Re Por` Fo.r wt b� <br />Sc,.bw1',4ea, �V% V"aW s-og &,j4s <br />Page 2 of 3 <br />1868 E. Hazelton Avenue i Stockton, California 95205 1 T 209 468-3421 209 464-0138 1 www.sjgov.org/EHD <br />