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Envtr mental H+alth ftment <br />Corrective Action Statem <br />May 04, 2O22,lJnderground Storage Tank report <br />. indicate if the violation has been corrected or will be by a ceftain date, <br />to correct the violation in the space provided below violation. Submit this <br />to Compliance Certification within 30 days of , lf you have anY q <br />please contact John Alaniz (209) 6 1 6-3053 or jalanizl @sjgov.org. <br />Submit form to: <br />"- il {::{"i 14 <br />lJ ".il i: i ut ,u' ;;,t + I Yt <br />For each violation listed <br />Also, describe what was <br />completed form with the <br />nt <br />Facility name: <br />Facility address: <br />CERS ID: <br />SMK <br />25651 N <br />10181 <br />PR0231 ST <br />Violation #208 - Failure to with the designated operator inspection <br />tr This violation was This violation will be by (date): <br />tr Supporting included <br />Describe actions taken will be taken to correct violation: <br />Page 2 of 2 <br />Stockton, California 95205 I T 209 468-3420 I <br />ENTAL HE:ALTH ARTMENT <br />ALANIZ <br />1868 E AZELTON AVENUE <br />, cA 95205 <br />SJC E <br />ATTN: <br />t LOL?- <br />209464-0138 | www. <br />Rev 9/16/2020 <br />1868 E. Hazelton .org/EHD