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r , <br /> SA JOAQUlN Environmental Health Department <br /> COUNTY -- <br /> Greotnets gr.-,s here <br /> Corrective Action Statement <br /> RE: January 05, 2022, 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 Vicky Vang-Lee at(209)616-3028 or vvang-lee@sjgov.org. <br /> Facility name: VALLEY PACIFIC LODI PLANT&CARDLOCK Submit completed form to: <br /> Facility address: 930 E VICTOR RD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10181885 ATTN:VICKY YANG-LEE <br /> PR0502817 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#115-Failure to submit"Monitoring System Certification Form"within 30 days of completion of the <br /> test. <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: We will ensure that test results are submitted within <br /> 30 days of testing. <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 <br /> Describe actions taken or will be taken to correct violation: We will ensure that test results are submitted within <br /> 30 days of testing, <br /> Violation#118-Failure to submit the"Overfill Prevention Equipment Inspection Report Form"within 30 days. <br /> El 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: We will ensure that test results are submitted within <br /> 30 days of testing. <br /> Rev 9/1612020 Page 2 of 3 <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 />