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SAN <br /> O ���� Environmental Health Department <br /> ti <br /> ;fir a . �' ,•-- - - t, OU N I Y --- <br /> -k4 <br /> .- tA . Greorness grows herel <br /> Corrective Action Statement <br /> RE : March 08, 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 taeiaw each viafation . Submit this <br /> completed form with the Return to Compliance Certification vrktfiin 30 days of inspection If you have any questions , <br /> please contact Vicky Varig- Lei at (2Q9) 616-3028 or vvang- lee@sj' gov. org <br /> Facility name . COUNTRY MARKETPLACE Submit completed form to .- <br /> Facility <br /> o:FaciEity address 178911V CHARTER WAY SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ! D ' 10182247 ATTN : DICKY VANG-LEE <br /> PRD506538 1868 E H/IZELTON AVENIJE <br /> STOCKTON , CA 95205 <br /> Violation #107 - Failure to submit and maintain complete and current financial responsibility documents. <br /> V"'mThis vEolation was corrected El This violation will be corrected by (date) : <br /> noo� Supporting documents included <br /> L-A <br /> 1 A <br /> Describe actions taken or will be taken to correct violation : �` <br /> (2� +� <br /> Violation #109 - Failure to submit " Designated Underground Storage Tank Operator Identification dorm" <br /> within 30 days . <br /> This violation was corrected C This violation will be corrected by (date): <br /> supporting documents included <br /> Describe actions taken or will tae taken to correct violation � � � �i �1 �. � _ U - - <br /> rc) <br /> SPEPWIM <br /> Page 2 of 4 <br /> Rev 91 Wzaza <br /> 1868 E Hazeilon Avenue Stockton , California 95205 T 2()9 468- 3420 F 209 464-0138 1 www . sjgov orglEHD <br /> e <br />