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M � I � Environmental Health Department <br /> u <br /> '- -COUNTY— <br /> Greatness <br /> COUNT <br /> Greatness grows here, <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@sjgov.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. <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: <br /> Page 2 of 2 <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 />