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SAN J Q A U I NEnvironmental Health Department <br /> } U I� -I- Y RECEIVED <br /> r10V` ,0 8 2021 <br /> Corrective Action Statement <br /> RE : April 21 , 2021 , Underground Storage Tank inspectilENIA rCNpMEt�NTAL HEALTH <br /> For each violation listed below , indicate if the violation has been corrected or will be corrected by a dein' a�T AENT <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 /> TOKAY SHELL , 420 W KETTLEMAN LN # 1 , CERS ID : 10767814 , PRO544259 <br /> Violation # 112 - Failure to have properly qualified service technician test leak detection equipment every 12 <br /> months . <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 : AVVI 4J7 I f <br /> d� •70 Y Yrs J�J6 ` Gf <br /> jo <br /> ALI <br /> 7 41/04ry �f � S /r�LC on i <br /> Oe <br /> Violation # 115 - Failure to submit " M nitorin System Ce tification Form " within 30 days of completion the <br /> test . Ai� a) jf! bCj Ct� A&PIt � � r`/� � YZ r" . � I��/1^� yoCrY, <br /> .�f This violation was corrected J ❑ This violation will be corrected by (date ) : <br /> ❑ Supporting documents included tt. b^ IL741 <br /> Describe actions taken or will be taken to correct violation : A1J <br /> kljool eel <br /> Violation # 116 - Failure to submit the " Spill Container Testing Report Form " within 30 days , <br /> tveag is violation was corrected ❑ This violation will be corrected by ( date) : <br /> ❑ Supporting documents included <br /> Describe actions taken or willLv <br /> en to correct violatio / <br /> L <br /> CAZ <br /> C <br /> �S <br /> Page 3 of 5 <br /> Rev. 9/ 16/2020 <br /> 1868 E . Hazelton Avenue I Stockton , California 95205 1 T 209 468- 3420 1 F 209 464- 0138 1 www . sjgov . org/EHD <br />