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A N O A Q U ( N Environmental Health Department <br /> --COUNTY— <br /> Greatness <br /> _ <br /> reatness grows Frere, <br /> Corrective Action Statement <br /> RE: May 21, 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 /> Shewit Woldearegay at(209)468-0216 or stwoldearegay(cDsigov.orq. <br /> Facility name: COSTCO WHOLESALE#1091 Submit completed form to: <br /> Facility address: 2680 REYNOLDS RANCH PKWY SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10146151 ATTN: SHEWIT WOLDEAREGAY <br /> PRO535432 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#103-Failure to submit and maintain complete and current financial responsibility documents. <br /> I& 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 /> t <br /> he 1,0651- cumellf ("79 /"/Xs a1o4We,,,-1 //,,-fo G r r -S a4-7a <br /> 4M 17, /74-f vet 51'te <br /> Violation#209-Failure to conduct the designated UST operator visual inspection at least once every 30 <br /> days. <br /> IM 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 /> e- 1vl5 I d 4 ' C clme!/I ei M ( ' ✓t? zlo 7�-- <br /> 30 aU�- � 'an <br /> vA Z- <br /> Rev.8/27/2019 Page 2 of 2 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />