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Environmental Health Department <br /> 3 <br /> Ss,` I <br /> COUNTY <br /> Corrective Action Statement <br /> RE: January 08, 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 form <br /> with the Return to Compliance Certification within 30 days of inspection. If you have any questions, please contact <br /> Stacy Rivera at(209)468-3440 or sriverapsigov.org. <br /> Facility name: SAFEWAY FUEL CENTER#1769 Submit completed form to: <br /> Facility address: 2802 COUNTRY CLUB BLVD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10156809 ATTN: STACY RIVERA <br /> PR0516736 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#104-UST operating permit application for facility and tank information not submitted or current. <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: The overfill protection method Was updated <br /> in CERS on 1/10/20 <br /> Violation#202-Failure to maintain the"Facility Employee Training Certificate"on-site(after October 1, <br /> 2018). <br /> ® This violation was corrected ❑This violation will be corrected by(date): <br /> 9 Supporting documents included <br /> Describe actions taken or will be taken to correct violation: Updated training forms included in email <br /> Page 2 of 3 <br /> Rev.8/27/2019 <br /> 1868 E. Hazelton Avenue i Stockton,California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />