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SAN JOAQUIN Environmental Health Department <br /> Corrective Action Statement <br /> RE: March 17, 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. Also, <br /> describe what was done to correct the violation in the space provided below each violation. Submit this completed form <br /> with the Return to Compliance Certification within 30 days of inspection. If you have any questions,please contact <br /> Stacy Rivera at orsrvera@sjgov.org. <br /> Facility name: SJ CO PUBLIC WORKS CORP YARD' Submit completed form to: <br /> Facility address: 1810 E HAZELTON AVE SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10181545 ATTN:STACY RIVERA <br /> PR0231141 1868 E HAZELTON AVENUE <br /> STOCKTON,CA 95205 <br /> Violation#109-"Designated Underground Storage Tank Operator Identification Form"not submitted within <br /> 30 days. <br /> IN This violation was corrected CI This violation will be corrected by(date): <br /> 13 Supporting documents Included <br /> Describe actions taken or will be taken to correct violatlon: 1/14/2021 uploaded new Designated Underground Storage <br /> Tank Operator Identification Form into CERS <br /> Violation#110-Failure to submit the"Underground Storage Tank Statement of Understanding and <br /> Compliance Form". <br /> 90 This violation was corrected 0 This violation will be corrected by(date): <br /> 13 Supporting documents Included <br /> Describe actions taken or will be taken to correct violation: 1/1412021 uploaded new Underground Storage Tank <br /> Statement of Understanding and Compliance form into CERS <br /> Page 2 of 3 <br /> Rev.82712019 <br /> r 1868 E. Hazelton Avenue I Stockton,California 952051 T 209 468-34201 F 209 464-0138 1 www.sjcehd.com <br />