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SAN _] OAQUIN Environmental Health Department <br /> COUNTY— <br /> Greotnesa grows he <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 #122-Failure to implement corrections and submit written response within 30 days of receiving the <br /> report. <br /> 0 This violation was corrected RThis violation will be corrected by(date): <br /> ❑ Supporting documents included <br /> Describe actions taken or <br /> will be taken to correct violation: (fr 7e,- Co✓/r CCT-L s a7 Ju/iM� <br /> 4-10,-C /,kM c�� <br /> Violation #202 -Failure to retain a paper or electronic copy of the permit to operate at the facility. <br /> P This violation was corrected 0 This violation will be corrected by(date): <br /> ❑ Supporting documents included <br /> Describe actions taken or will be taken to correct violation: 7`1/f 4 ' <br /> ­4�C ��� C D �� C Ci► s/y<<7�p�.� , S <br /> �t/�C f/l /' Gti/,w,'! n o r y � /i D�h/�i '1 U��., �oC✓ra Pry J� <br /> T <br /> Violation #205-Failure to have current UST Monitoring Plan readily accessible at the facility. <br /> I' This violation was corrected ErThis violation will be corrected by(date): Z/—/ Y <br /> ❑ Supporting documents included <br /> Describe actions taken or will be taken to correct violation: 'n Xe d-7 7,-r <br /> �n 5-4 <br /> Page 4 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 />