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Received <br /> 9/7/2023 <br /> r, ANJ 0 AQ I I Environmental Health Department IN <br /> N`'-i' COUNTY <br /> Greatness grows here. <br /> Corrective Action Statement <br /> RE: July 28, 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: AISLE 1 #2356 Submit completed form to: <br /> Facility address: 4219 E MORADA LN SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10185183 ATTN: SHEWIT WOLDEAREGAY <br /> PR0524617 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#107-Failure to submit and maintain complete and current financial responsibility documents. <br /> jj This violation was corrected ❑This violation will be corrected by(date): <br /> Q Supporting documents included <br /> Describe actions taken or will be taken to correct violation: Updated in CERS 7/7/23. <br /> Violation#109-Failure to submit"Designated Underground Storage Tank Operator Identification Form" <br /> within 30 days. <br /> Q 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: Submitted in CERS 7/7/23. <br /> Page 2 of 4 <br /> Rev.9/16/2020 <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 />