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S ,J <br /> Environmental Health Department <br /> 0 AP U IN <br /> Corrective Action Statement <br /> RE: April 25, 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 John Alaniz at (209)616-3053 orjalanizl@sjgov.org. <br /> Facility name: WOODBRIDGE AM PM* Submit completed form to: <br /> Facility address: 18806 N LOWER SACRAMENTO RD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10/81237 ATTN: JOHN ALANIZ <br /> PR0232388 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation 9109 -Failure to submit"Designated Underground Storage Tank Operator Identification Form" <br /> within 30 days. <br /> 9 This violation was corrected ❑This violation will be corrected by(date): S "� <br /> ❑ Supporting documents included <br /> Describe actions taken or will be taken to correct violation: <br /> YV L� C) E F,S 15AC r� OfuIm <br /> Violation#122-Failure to implement corrections and submit written response within 30 days of receiving the <br /> report. <br /> J; This violation was corrected ❑This violation will be corrected by(date): <br /> ❑ Supporting documents included /� r <br /> Describe actions taken or will be taken to correct violation: I �V ��� 5���✓tl�e(� _l P 1 �2i� <br /> LCA <br /> Page 2 of 4 <br /> Rev.9/16/2020 <br /> 1868 E. Hazelton Avenue ( Stockton, California 95205 1 T 209 468-342.0 1 F 209 464-0138 1 www.sjgov.orcg,EHD <br />