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� 1If1 �AI Environmental Health Department <br /> 11 V N <br /> u _ <br /> C U N T <br /> r Greatness grows here, <br /> Corrective Action Statement <br /> RE: January 12, 2026, 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 /> Aaron Madera at(209)616-3065 or amadera@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:AARON MADERA <br /> PR0231211 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#7-2011004-Owner/Operator submitted DO form within 30 days of UST install or DO change(TCR <br /> 10). <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: <br /> Belshire send an updated certificate with the inspector name corrected. <br /> Violation#40-2011002-Installation, repair, lining, integrity,calibration,and release records maintained for <br /> life of UST. <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: <br /> Close out construction packet was provided to the inspector including as-builds <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 />