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Environmental Health Department <br /> SAN , JOAQUIN <br /> �.!Rh>v — COUNTY <br /> Greotness grows fere. <br /> Corrective Action Statement <br /> RE: December 29, 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. <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 Vicky Vang-Lee at(209)616-3028 or vvang-lee@sjgov.org. <br /> Facility name: FOOD 4 LESS FUEL CENTER' Submit completed form to: <br /> Facility address: 3408 MANTHEY RD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10184365 ATTN:VICKY YANG-LEE <br /> PR0517521 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#118-Failure to submit the"Overfill Prevention Equipment Inspection Report Form"within 30 days. <br /> W 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: moving forward we will make sure all testing <br /> reports are submitted within the 30 days of the due date. <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 /> ❑ Supporting documents included <br /> Describe actions taken or will be taken to correct violation: moving forward we will make sure the corrective <br /> action statement is returned within the 30 day of the due date. <br /> Violation#204-Failure to maintain records of repairs,lining,and upgrades on site,for the life of the UST. <br /> 13' 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: the work order for the bucket replacement was <br /> not on site, we will make sure all copies of work order will remain onsite. a copy will be <br /> submitted with corrective action report. <br /> Page 2 of 3 <br /> Rev.9/16/2020 <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />