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Environmental Health Department <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 />SJC ENVIRONMENTAL HEALTH DEPARTMENT <br />ATTN: SHEWIT WOLDEAREGAY <br />1868 E HAZELTON AVENUE <br />STOCKTON, CA 95205 <br />Facility name: <br />Facility address: <br />CERS ID: <br />Submit completed form to:QUIK STOP MARKET #120 <br />10181013 <br />9321 N THORNTON RD <br />PR0231261 <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 />Violation #208 - Failure to comply with the designated operator inspection requirements. <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 />Violation #306 - Failure to remove, analyze, and properly dispose of water in secondary containment (pre-Jul <br />2003). <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 />Page 2 of 2 <br />Rev. 9/16/2020 <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/EHD <br />244725095 has been issued to Elite IV to pump out the sumps. <br />X <br />Current Financial Responsibility documents have been sent to the site and will be available for review in <br />the future. <br />X <br />Future designated operator reports will include all of the required information. <br />X