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SAN �� IIIN Environmental Health Department <br /> -COUNTY <br /> Greotness grows here. <br /> r. <br /> Corrective Action Statement <br /> RE: May 13, 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(baker@sjgov.org. <br /> Facility name: SAFEWAY FUEL CENTER#2707 Submit completed form to: <br /> Facility address: 6425 N PACIFIC AVE SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10156811 ATTN: LYDIA BAKER <br /> PR0231211 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#202-Failure to retain a paper or electronic copy of the permit to operate at the facility. <br /> IN This violation was corrected ❑This violation will be corrected by(date): <br /> ❑ Supporting documents included <br /> SJC provided a copy of the current permit <br /> Describe actions taken or will be taken to correct violation: <br /> and it was emailed to the station <br /> Violation#208-Failure to comply with the designated operator inspection requirements. <br /> ❑ This violation was corrected ®This violation will be corrected by(date): going forward <br /> ❑ Supporting documents included <br /> Describe actions taken or will be taken to correct violation: The station manager was Instructed to have <br /> written responses to items that need attention. <br /> Violation#307-Failure to keep water out of the secondary containment system(post-Jul 2003). <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 water was removed from the noted sumps <br /> on the day of the monitor cert. <br /> Page 2 of 3 <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 />