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UST <br /> SAN , J OAO U IN Environmental Health Department <br /> �__�4 <br /> COUNTY <br /> Corrective Action Statement <br /> RE : December 16 , 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 Elianna Florido at (209) 616-3050 or eflorido@sjgov. org . <br /> Facility name : WESTERN FOOD & FUEL Submit completed form to : <br /> Facility address : 3032 E WATERLOO RD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : 10180877 ATTN : ELIANNA FLORIDO <br /> PR0231758 1868 E HAZELTON AVENUE <br /> STOCKTON , CA 95205 <br /> Violation #107 - Failure to submit and maintain complete and current financial responsibility documents . <br /> O/This violation was corrected ❑ This violation will be corrected by (date) : <br /> ❑ Supporting documents included <br /> Describe actions take , or will be taken to correct violation : <br /> L <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 violatio <br /> Violation #118 - Failure to submit the " Overfill Prevention Equipment Inspection Report Form " within 30 days . <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 : <br /> © r) vl t , aS e v. -� V�✓I A Lia rn +fS01 (1V\ 01 - 10 -e? 2 . <br /> Page 2 of 3 <br /> Rev. 9/16/2020 <br /> 1868 E . Hazelton Avenue ( Stockton , California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www. sjgov . org/EHD <br />