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Environmental Health Department <br />SAW J 0 A 0 U I N <br />`t CUUNTY <br />i� 01 Greotness grows here. <br />Corrective Action Statement <br />RE: August 31, 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 />STOP N SHOP, 1856 W COUNTRY CLUB BLVD, CERS ID: 10180831, PR0231069 <br />Violation #110 - Failure to submit the "Underground Storage Tank Statement of Understanding and <br />Compliance Form". <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: C ,VM �Oc- <br />Violation <br />#112 - Failed to test monitoring and leak detection equipment every 12 months. <br />W'—This violation was corrected ❑ This violation will be corrected by (date): <br />❑ Supporting documents included f) <br />Describe actions taken or will be taken tq correct violation: <br />Violation #115 - Failure to submit "Monitoring System Certification Form" within 30 days of completion of the <br />test. <br />Rev. 9/16/2020 <br />Gr—This violation was corrected <br />Sif Supporting documents included <br />❑ This violation will be corrected by (date): <br />AA N1,Describe actions taken or will be taken to correct violation: �'� <br />Page 4 of 7 <br />I <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 />