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SANJEnvironmental Health pt <br /> Corrective Action Statement <br /> RE: July 18, 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 Stacy Rivera at(209)616-3043 or srivera@sjgov.org. <br /> Facility name: ORLANDOS Submit completed form to: <br /> Facility address: 18754 E HWY 26 SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10182295 ATTN: STACY RIVERA <br /> PR0507164 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#102-Failure to submit a complete and accurate application for a permit to operate a UST. <br /> Lir/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 /> C66eirWfbn avc t v)c I' V,-('4lq/*A ,S <br /> C' ,27g box I alt E/o pt " (,AeekeW <br /> Violation#107-Failure to submit and maintain complete and current financial responsibility documents. <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 co ect violation: (� ✓r"e . .rIel` <br /> f r e <br /> b <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: <br /> B r t <br /> Rev.9/16/2020 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 />