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S AN 10 A Q U I N Environmental Health Department <br />i ,! <br />1'Y <br />Corrective Action Statement <br />RE: May 03, 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: QUIK STOP MARKET #120 <br />Submit completed form to: <br />Facility address: 9321 N THORNTON RD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br />'ERS ID: 10181013 ATTN: SHEWIT WOLDEAREGAY <br />PR0231261 1868 E HAZELTON AVENUE <br />STOCKTON, CA 95205 <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 correct violation: <br />Current Financial Responsibility documents have been sent to the site and will be available for review in <br />the future. <br />Violation #208 -Failure to comply with the designated operator inspection requirements. <br />M <br />1 This violation was corrected <br />❑ Supporting documents included <br />❑ This violation will be corrected by (date): <br />Describe actions taken or will be taken to correct violation: <br />Future designated operator reports will include all of the required information. <br />Violation #306 -Failure to remove, analyze, and properly dispose of water in secondary containment (pre -Jul <br />2003). <br />N <br />Rev. 9116/2020 <br />This violation was corrected <br />❑ Supporting documents included <br />❑ This violation will be corrected by (date): <br />Describe actions taken or will be taken to correct violation: <br />244725095 has been issued to Elite IV to pump out the sumps. <br />Page 2 of 2 <br />1868 E. Hazelton Avenue � Stockton, California 95205 � T 209 468-3420 � F 209 464-0138 � www.sjgov.org/EHD <br />