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SAN 1OAQUIN EnvironmB EI IEDIi: NOV 4 8 2021 Corrective Action Statement ENVIRONMENTAL HEALTH RE : April 21 , 2021 , Underground Storage Tank inspection repoQEPARTMENT For each violation listed below , indicate if the violation has been corrected or will be corrected by a certain date . Also , describe what was done to correct the violation in the space provided below each violation . Submit this completed form with the Return to Compliance Certification within 30 days of inspection . If you have any questions , please contact Vicky Vang - Lee at (209) 616-3028 or vvang - lee@sjgov . org . Facility name : TOKAY SHELL Submit completed form to : Facility address : 420 W KETTLEMAN LN # 1 SJC ENVIRONMENTAL HEALTH DEPARTMENT CERS ID : 10767814 ATTN : VICKY YANG - LEE PR0544259 1868 E HAZELTON AVENUE STOCKTON , CA 95205 Violation # 102 - Failure to submit a complete and accurate application for a permit to operate a UST . �] This violation was corrected ❑ This violation will be corrected by ( date) : ❑ Supporting documents included Describe actions taken or will be take ` to correct violation : � l ��/� �� d2 l U ' u _h , by JoAbd . Violation # 104 - Failure to have an approved UST Monitoring Plan . ,,ET'This violation was corrected ❑ This violation will be corrected by ( date) : ❑ Supporting documents included Describe Actions taken or will be taken to correct violation :lasorowthS r / Ill) , 1A p chr we, Xi// 5;4,0K/ 7 /n � le),A Violation # 107 - Failure to submit and maintain complete and current financial responsibility documents . I I This violation was corrected ❑ This violation will be corrected by ( date ) : ❑ Supporting documents included Des ribe actions taken or will be taken to correct violation : 0k.1lifila LS V/V AOIA J I. W W Page 2 of 5 Rev 9/ 16/2020 1868 E . Hazelton Avenue I Stockton , California 95205 1 T 209 468- 3420 1 F 209 464 -0138 1 www . sjgov . org/EHD