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SAN J OAQ U I N Environmental Health Department <br />IU:x)1 Y <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 />PACIFIC AVE, 6131 PACIFIC AVE, CERS ID: 10180905, PR0231223 <br />Violation #10 - 2030074 -Annual Monitoring System Certification Form to the CUPA within 30 days of <br />completion of the test, <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: Per our agreement, our testing company Eco-Chek <br />is responsible for submitting test results to county within the prescribed timeframe. Met with owner <br />to reiterate this and to make sure that this is remediated for future testing. <br />Violation #13 - 2010017 - Spill bucket testing results submitted to the UPA within 30 days of testing. <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: same as above <br />Violation #53 - 2010007 - Submittedlmaintained current Cert of Financial Responsibilitylmech of financial <br />assurance (TCR 11 ). <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 />have been Updated Financial Re <br />attached and uploaded into CERS. <br />Page 3 of 4 <br />ne�.snsnozs <br />sponsiblity Documents <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 />