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SANJOAQUIN Environmental Health Department <br />CourlTv - <br />Corrective Action Statement <br />RE: August 13, 2024, inspection report <br />For each violation listed below, indicate if the violation has been corrected or will be corrected by a certain date. Also, <br />describe what was done to correct the violation in the space provided below each violation. Submit this completed form <br />with the Return to Compliance Certification within 30 days of inspection. If you have any questions, please contact <br />Lynsey Sammons at (209) 616-3067 or Isammons@sjgov.org. <br />Facility name: PACIFIC AVE <br />Submit completed form to: <br />Facility address: 6131 PACIFIC AVE SJC ENVIRONMENTAL HEALTH DEPARTMENT <br />CERS ID: 10180905 ATTN: LYNSEY SAMMONS <br />PR0231223 1868 E HAZELTON AVENUE <br />STOCKTON, CA 95205 <br />Violation #2 - 2010010 - Complete and accurate UST Operating Permit Application has been submitted.. <br />This violation was corrected ❑This violation will be corrected by (date): <br />❑ Supporting documents included <br />Describe actions taken or will betaken to correct violation: Reviewed all Sections of CERS and could not <br />locate any areas which incorrectly state that facility is on tribal lands. All information in the <br />facility information tabs and permit application sections of CERS are correct. <br />Violation #3 - 2010013 -Facility has submitted a complete and accurate UST Monitoring Plan.. <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 />and submitted for review and approval by EHD. <br />Corrected annual sensor model numbers in CERS <br />Violation #5 - 2030041 - A current facility plot plan is maintained and has been submitted. <br />C� This violation was corrected 13 This <br />violation will be corrected by (date): <br />❑ Supporting documents included <br />Describe actions taken or will be taken to correct violation: Environmental Services Company Corrected <br />the site map and added the notation of where the floats and chains are located on the property. <br />Updated site map was uploaded into CERS. <br />Page 2 of 4 <br />ae�. sns�zaza <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.org/EHD <br />