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SAN JOAQUIN <br />----COUNTY <br />Greotness grows her, <br />Environmental Health Department <br />Corrective Action Statement <br />RE: November 19, 2020, 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. Also, <br />describe what was done to correct the violation in the space provided below each violation. Submit this completed <br />form with the Return to Compliance Certification within 30 days of inspection. If you have any questions, please <br />contact Paul Nso at (209) 616-3049 or pnso@sjgov.org. <br />Supervalu, 1990 N PICCOLI RD, CERS ID: 10181455, PRO231820 <br />Violation #113 - Failure to conduct secondary containment testing. <br />Et/ This violation was corrected aThis violation will be corrected by (date): //- 2 o- /y <br />Supporting documents included <br />Describe actions taken or will be taken to correct violation: ,Z)L,P7 ,1 2 f17/;-, -71( A2o) r <br />iv <br /> <br />aJ 7-42k,-), A e g 7 4,„.1 r-i-,6(ee/ on Z 2- /2.1 t? / _ et <br />A3 2 <br />-11-4 fjr 74 4 C(277c- 0714-- V;Iiict / 2—'77 ./7.,f 72"yfrirY 1 7,01 - <br />Violation #117 - Failed to submit "Secondary Containment Testing Report Form" within 30 days after the test. <br />E This violation was corrected Er This violation will be corrected by (date): /7" Jo <br />Supporting documents included <br />Describe actions taken or will be taken to correct violation: 4). /e‘r/sie Ze I /al /foci) hi <br />"K=> fc (4 cif e eotic kor /7 4cc i, A 7 <br />rra ,Am Yr' n <br />Violation #118 - Failure to submit the "Overfill Prevention Equipment Inspection Report Form" within 30 days <br />ar This violation was corrected ErThis violation will be corrected by (date): /1"- --7 ° - 7 — <br />Supporting documents included <br />Describe actions taken or will be taken to correct violation: -nis(4 LI: My 7:,--Q0 A (,. v - d f <br />74-FP f j-- C 14 ,..,,7 ,4v-ri e,-7 7-.. / /74'4/7-4 v i q DC, r'' .--,/ 7 41' i)'? 4 / 7- i,/eci e <br />e <br /> <br />e.,1 <br /> <br />“5 .1- .47-741e0 o'le'rr <br />Page 3 of 5 <br />Rev. 9/16/2020 <br />1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 I F 209 464-0138 I www.sjgov.org/EHD