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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, Hazardous Waste 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 /> PR0513740 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#110-Failed to keep signed copy of manifests from the designated facility for three years. <br /> f] This violation was corrected ❑This violation will be corrected by(date): <br /> 1Z Supporting documents included <br /> Final manifests were sent to station on <br /> Describe actions taken or will be taken to correct violation: <br /> 6/3/21. Manifests are attached to email as well. Note: I included 020590873 JJK as well <br /> it was not on the inspection report but was on the email you had with pictures. <br /> Violation#111 -Failed to comply with uniform hazardous waste manifest exception 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: Not applicable final manfests was available <br /> on haz waste contractor website. <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 />