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FEB/24/2021/WED 06; 05 PM Tracy Truck Stop FAX No, 209832 2312 P, 002 <br /> SAV j Environmental He Department <br /> Health D <br /> Corrective Action Statement <br /> RE: February 09, 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: Tracy Blvd Chevron Submit completed form to: <br /> Facility address: 3775 N TRACY BLVD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10181337 ATTN: PAUL NSO <br /> PR0231418 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation #110 - Failure to submit the "Underground Storage Tank Statement of Understanding and <br /> Compliance Form", <br /> V 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 /> S L4- PQ-11 <br /> N� <br /> Violation #113 - Failure to conduct secondary containment testing. <br /> This violation was corrected ❑ This violation will be corrected by (date): <br /> 1� Supporting documents included <br /> Describe actions taken or will betaken to correct,violation: urn tx _tzt�� <br /> CIO <br /> Rev.9/16/2020 Page 2 of 3 <br /> R e�cFR Fed T m{2 nF e b- 2 4, 1 2 0 2 k6 : F2P' SN o, 66T4-9 I T 209468-31 F 209 464-0138 1 www,sjgov.org/EHD <br />