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r, SIN <br /> ANJ 0 AQ I I Environmental Health Department <br /> COUNTY <br /> Greatness grows here. <br /> Corrective Action Statement <br /> RE: May 11, 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 Kristina Saetern at(209)616-3045 or ksaetern@sjgov.org. <br /> Facility name: FLYING J TRAVEL PLAZA#618' Submit completed form to: <br /> Facility address: 1501 N JACK TONE RD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10182131 ATTN: KRISTINA SAETERN <br /> PR0505264 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#117-Failed to submit"Secondary Containment Testing Report Form"within 30 days after the test. <br /> IN 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: Secondary containment Dipina testina was completed on T1, <br /> T4,T5, T6 and diesel trunk lines 25-30 and 26 satellite conducted on 4/21/23 and results have been previously provided and <br /> accepted by the Dept. Remaining secondary containment testing took place on 6/15/23. Test results are attached. <br /> Violation#214-Failure to comply with UST operating permit conditions. <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: All repairs were covered by permit addendums. March 15, 2023 <br /> ArlrlPnrlum 1 -u rn'ttwi fnr 9 arlditinnal annular risers nt 1 -7 Tank 1-90 000 gal clopsPI 1 -11 Tank 5-19 000 gal q1_ 4/7/93 s��hmltted <br /> Addendum 2 for T6 Diesel Annular L-12.And 4/20/23 Addendum 3 submitted for T2 DSL piping sump entries. <br /> Addendum 1 approved 3/30;Addendum 2 approved 4/20;Addendum 3 approved 6/7. <br /> Page 2 of 2 <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 />