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A N O Q N Environmental Health Department <br /> C-0 U <br /> Corrective Action Statement <br /> RE: January 08, 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@s)gov.org. <br /> Facility name: KWIK SERV LODI BW 113* Submit completed form to. <br /> Facility address: 420 W KETTLEMAN LN SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10181407 ATTN CAROL PRESTO <br /> PR0231906 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#104-Failure to have an approved UST Monitoring Plan. <br /> Ed 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#106-Failure to submit and maintain a current facility plot plan 1 site map. <br /> G( 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 /> �N -- <br /> Violation#122-Failure to implement corrections and submit written response within 30 days of receiving <br /> the report. <br /> Q( 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 /> CIIy'xU1 6LV\e3<' W V-'r 4-\ <br /> Page 2 of 3 <br /> Rev.911612020 <br /> 1868 E. Hazelton Avenue f Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />