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s a N JOAN N Environmental Health Department <br /> COUNTY <br /> Corrective Action Statement <br /> RE: December 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. Also, <br /> describe what was done to correct the violation in the space provided below each violation. Submit this completed <br /> form with the Return to Compliance Certification within 30 days of inspection. If you have any questions, please <br /> contact Etienne Florido at (209) 616-3050 or efloddo@sjgov.org. <br /> Facility name: Nella Oil #427 Submit completed form to: <br /> Facility address: 3300 Waterloo Rd SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10124584 ATTN : ELIANNA FLORIDO <br /> PR0231765 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation #122 - Failure to Implement corrections and submit written response within 30 days of receiving the <br /> report. <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: Provided RTC documentation from the UST inspection <br /> that occurred on 12/16/2020. <br /> Violation #203 - Failure to maintain monitoring records for 36 months and maintenance records for 60 <br /> months. <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: Mailed a hardcopy Overfill Prevention Equipment <br /> Inspection Report from 12/16/2020 to be posted on site in the compliance binder. All missing maintenance <br /> and monitoring records for the last three years have been located and submitted to EHD. <br /> Page 2 of 3 <br /> Rev. 9/76/2020 <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 />