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SAN JOADIN Environmental Health Department <br /> C ' t ' N ( Y <br /> Corrective Action Statement <br /> RE : September 13 , 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: Delta arco Submit completed form to: <br /> Facility address: 440 W DR MARTIN LUTHER KING JR BLVD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10180903 ATTN : PAUL NSO <br /> PR0231055 1868 E HAZELTON AVENUE <br /> STOCKTON , CA 95205 <br /> Violation #112 - Failure to have properly qualified service technician test leak detection equipment every 12 <br /> months. <br /> ❑ This violation was corrected This violation will be corrected by (date) : <br /> ❑ Supporting documents included t <br /> -- <br /> Describe actions taken orwillbe taken to correct violation :Ai <br /> � itl (drt � PC } , tN � tn � t nn � ,t tl G�Lllcty <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 y ( <br /> Describe actions taken or will be taken to correct violation: in ' fi <br /> eq <br /> UV <br /> Violation #318 - Failed to meet spill container requirements. <br /> ❑ This violation was corrected I This violation will be corrected by (date) : <br /> ❑ Supporting documents included i <br /> Desc 'be actions taken or will be taken to correct violation : _ f W C Will A:„A j � 5 tkn� <br /> to <br /> Rev. 9/16/2020 Page 2 of 2 <br /> 1868 E. Hazelton Avenue I Stockton , California 952051 T 209 468-3420 1 F 209 464-0138 I www. sjgov. org/EHD <br />