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h�QHEnvironmental Health Department <br />�- 4QV <br />r <br />_C 0UNTY <br />,: • Greatness grows here. <br />Corrective Action Statement <br />RE: January 13, 2023, 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 Shewit Woldearegay at (209) 616-3063 or stwoldearegay@sjgov.org. <br />Facility name: VALLEY PACIFIC CHARTER WAY CARDLOCK Submit completed form to: <br />Facility address: 1501 W CHARTER WAY SJC ENVIRONMENTAL HEALTH DEPARTMENT <br />CERS 0: 10181557 ATTN: SHEWIT WOLDEAREGAY <br />PR0231989 1868 E HAZELTON AVENUE <br />STOCKTON, CA 95205 <br />Violation #122 -Failure to implement corrections and submit written response within 30 days of receiving the <br />report. <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 />We will respond with a written response within the 30day window. <br />Page 2 of 2 <br />Rev. 9l161202D <br />1868 E. Hazelton Avenue j Stockton, California 95205 I T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />