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SAN J O AQ U I N Environmental Health Department <br /> _l.Y <br /> Corrective Action Statement <br /> RE: September 27, 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 Lydia Baker at(209)616-3046 or(baker@sjgov.org. <br /> ST JOSEPHS HOSPITAL, 1800 N CALIFORNIA ST, CERS ID: 10181391, PR0231036 <br /> Violation#115-Failure to submit"Monitoring System Certification Form"within 30 days of completion of the <br /> test. <br /> ❑ This violation was corrected :g This violation will be corrected by(date): <br /> ❑ Supporting documents included r � �, + <br /> Describe actions taken or will be taken to correct violation: Urtj� Wo& L,1(L t"'� <br /> CUOL QA 0, 0 T0 6 Oulrt415, PO)W, 5U 1 L <br /> CRS l E 5'AT/S'r(E/2 <br /> Violation#203-Failure to maintain monitoring records for 36 months and maintenance records for 60 <br /> months. <br /> i/This violation was corrected ❑This violation will be corrected by(date): <br /> Supporting documents included �} ,,r <br /> Describe actions taken or will be ken to correct violation: CAR!' SCJ W �t`� <br /> ash � z6 <br /> A SMATt. s 0 l-1 oN CM V <br /> Violation#208-Failure to comply with the designated operator inspection requirements. <br /> ❑ This violation was corrected ®°t•his violation will be corrected by(date): f/IA� -T 6 rWr-t <br /> ❑ Supporting documents included r�(,��/4►�-CJ <br /> Describe actions taken or will be taken to c rrectyi lotion: <br /> Od G'ITC STA f Lj <br /> Page 3 of 4 <br /> Rev.911612020 <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www sjgov.orglEHD <br />