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SAN J U A Q U I N Environmental Health © epart �ieni <br /> C> UNIY <br /> Corrective Action Statement <br /> RE : February 22 , 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. <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 Paul Nso at (209 ) 616-3049 or pnso@sjgov . org . <br /> Facility name : LATHROP SHELL Submit completed form to: <br /> Facility address : 16500 S HARLAN RD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : 10181913 ATTN: PAUL NSO <br /> 1868 E HAZELTON AVENUE <br /> PR0231554 STOCKTON , CA 95205 <br /> Violation #113 - Failure to conduct secondary containment testing . <br /> 1S This violation was corrected ❑ This violation will be corrected by (date ) : <br /> ❑ Supporting documents included rr <br /> Describe actions taken or will be taken to correct viollation : G ' l�`'- "a <br /> � ed i% Q, 1ecoi^ Glcf � I G, r, I a' I III e 11 J C <br /> 11 ,j + yJC' J JA Hiitocl1O uGv , 1G(? <br /> 1 Gi c � �I <br /> Violation #117 - Failed to submit " Secondary Containment Testing Report Form " within 30 days after the test . <br /> ® This violation was corrected ❑ This violation will be corrected by (date) : <br /> ❑ Supporting documents included I <br /> Describe actions taken or will be taken to correct violation : ��' e V1G \ q"� 1U ,h <br /> Violation #122 - Failure to implement corrections and submit written response within 30 days of receiving the <br /> report . <br /> L3 This violation was corrected ❑ This violation will be corrected by (date ) : <br /> ❑ Supporting documents included ,tt <br /> Describe actions taken or will be taken to correct violation : <br /> Page 2of3 <br /> Rev. 9/16/2020 <br /> 1868 E . Hazelton Avenue I Stockton , California 95205 1 T 209 468-3420 1 F 209 464 -0138 www . <br /> sjgov . org/ EHD <br />