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N JOAQUIN Environmental Health Department <br /> COUNTY <br /> Corrective Action Statement <br /> RE: March 16, 2021, 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 /> Vicky Vang-Lee at(209)616-3028 or vvang-lee gsjgov.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:VICKY VANG-LEE <br /> PR0516736 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#208-Failure to comply with the designated operator inspection requirements. April 27, 2021 (next <br /> © This violation was corrected DO This violation will be corrected by(date): Scheduled DO inspection) <br /> © Supporting documents included <br /> Describe actions taken or will be taken to correct violation: Follow-up action for Compliance IsSuse noted <br /> in Section 3 of the DO report will be described in Section 5 of the DO report. <br /> The DO will note the correct date of the Monitor Cert cioing forward. <br /> Page 2 of 2 <br /> Rev.911612020 <br /> 1868 E. Hazelton Avenue I Stockton,California 95205 1 T 209 468-3420 1 F 209 464-01138 1 www.sjgov.orglEHD <br />