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" J�N1OAQf� IAJ Environmental Health Department <br /> ,+� �� ,K 1 �1 V 1 [� <br /> �,- <br /> ��'' — COUNTY <br /> Greotness grov. I.,,, <br /> Corrective Action Statement <br /> RE: March 25, 2024, 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: CAGASOLINE INC Submit completed form to: <br /> Facility address: 2115 W YOSEMITE AVE SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10186687 ATTN: SHEWIT WOLDEAREGAY <br /> PR0526335 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#102-Failure to submit a complete and accurate application for a permit to operate a UST. <br /> This violation was corrected ❑This violation will be corrected by(date): <br /> ❑ Supporting documents included <br /> 7 <br /> Describe actions taken or will be taken to correct violation: I A "i kA 4, <br /> t r <br /> Violation#107-Failure to submit and maintain complete and current financial responsibility documents. <br /> ]9/ This violation was corrected ❑This violation will be corrected by(date): <br /> ///❑ Supporting documents included <br /> 9 <br /> Describe actio s taken or will be taken to correct violatio <br /> �2 <br /> IVI <br /> t <br /> L2� , - rp <br /> Violation#109-Failure to submit"Designated Underground Storage Tank Operator Identification Form" <br /> within 30 days. <br /> This violation was corrected L3This violation will be corrected by(date): <br /> ❑ Supporting documents included <br /> Describe actions taken or will be taken to correct violation: <br /> A I <br /> /V`A✓•til_ <br /> Page 2 of 5 <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 />