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N40IIIN Environmental Health Department <br /> I�1 1J <br /> COUNTY <br /> Greotness grows here. <br /> r. <br /> Corrective Action Statement <br /> RE: September 21, 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: 7-ELEVEN INC#14113 Submit completed form to: <br /> Facility address: 3040 W BENJAMIN HOLT DR SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10165777 ATTN: SHEWIT WOLDEAREGAY <br /> PR0506497 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#203-Failure to maintain monitoring records for 36 months and maintenance records for 60 <br /> months. <br /> CA This violation was corrected ❑This violation will be corrected by(date): <br /> N Supporting documents included <br /> Describe actions taken or will be taken to correct violation: <br /> Maintenance work order placed onsite by DO. <br /> Violation#307-Failure to keep water out of the secondary containment system(post-Jul 2003). <br /> 14 This violation was corrected ❑This violation will be corrected by(date): <br /> IN Supporting documents included <br /> Describe actions taken or will be taken to correct violation: <br /> Minor repairs completed at 87 fill lid & sump confirmed liquid-tight. <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 />