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f1rO1 �N Environmental Health Department <br /> ISI U <br /> Greatness 9rowf. here. <br /> Corrective Action Statement <br /> RE: February 16, 2023, Hazardous Materials 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 /> Paul Nso at(209)616-3049 or pnso@sjgov.org. <br /> Facility name: SAFEWAY FUEL CENTER#0055 Submit completed form to: <br /> Facility address: 19533 S MOUNTAIN HOUSE PKWY SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10902574 ATTN: PAUL NSO <br /> PR0547764 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#6-Failed to electronically submit a site map with all required content. <br /> M 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: CERS updated 3/7/2023 <br /> Violation#11 -Failed to provide or document initial and/or refresher training to appropriate personnel. <br /> M This violation was corrected ❑This violation will be corrected by(date): <br /> X Supporting documents included <br /> Describe actions taken or will be taken to correct violation: Employees were retrained on 3/6/2023, see select pages <br /> and training sign off. <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 />