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Environmental Health Department <br /> .j <br /> N AOAQU N <br /> _... _ 0 U N T Y: ; <br /> a +�tnass gr*r�s be o— <br /> Corrective Action Statement <br /> RE; May 18, 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. <br /> Also, describe what was done to correct the violation in the space provided below each violation. Submit this <br /> completed form with the Return to Compliance Certification within 30 days of inspection. If you have any questions, <br /> please contact Lydia Baker at(209)616-3046 or Ibaker@sjgov.org. <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:.LYDIA BAKER <br /> PR0536432 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#122-Failure to implement corrections and submit written response within 30 days of receiving the <br /> report. <br /> ❑ This violation was corrected 11 This violation will be corrected by(date): <br /> Supporting documents included <br /> 96 <br /> Describe actions taken or will be taken to correct violation: �n <br /> 4'1 lu 40(t <br /> Violation#208-Failure to comply with the designated operator inspection requirements. <br /> ❑ 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: 6 AAA0f4rqAd 1� 4Wi <br /> o <br /> Al qA <br /> �C.i <br /> Page 2of2 <br /> Rev,911612020 <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 />