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1 <br /> SAN 10AQU I N Environmental Health Department <br /> - -COUNTY --- ._ <br /> Greatness grows her- <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, PR0231820 <br /> Violation #113-Failure to conduct secondary containment testing. / <br /> I3 This violation was corrected CTThis violation will be corrected by(date): <br /> ❑ Supporting documents included <br /> Describe actions taken or will be taken to correct violation: T <br /> ,,&1)7 bv.i e,/ on 1,7—127 m/moi . (Pc 4lrzC!,e v� <br /> Z /d! 2 �(n�t•s�/'P✓✓ y �TP�.r9 C �An�""7C /!./i�/�..C c-'� `'1�n��'r�''0�"iG/ <br /> �( �✓4ze 7,t, Lx --717 1 aii 46., <br /> Violation #117-Failed to submit"Secondary Containment Testing Report Form" within 30 days after the test. <br /> 0" This violation was corrected EfThis violation will be corrected by(date): <br /> ❑ Supporting documents included <br /> Describe actions taken or will be taken to correct violation: 7,j h/ul /J,v vi 4le-I <br /> 7Lp J1 C �iiy/r.v&e07`4t 1�ea/7ti ,iia �v,,- 17i� !�7 .ins./, 2Ir,i` 1« <br /> Zn 6-4ermcn -r fr` Gi l 7'ae11lhNny jT <br /> Violation #118-Failure to submit the "Overfill Prevention Equipment Inspection Report Form" within 30 days, <br /> ®' This violation was corrected Q"This violation will be corrected by(date): <br /> ❑ Supporting documents included <br /> Describe actions taken or will be taken to correct violation: ��+(�S i�Cb�.N�ti���1 E�yQr 02ro,/',�,' <br /> P J e�v1 K. �/l'A/Th c/ I e C/ !,t- �i r �j 7M a[ / ;el"/e" <br /> Page 3 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 />