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r <br /> - SAN 10AQUIN Environmental Health Department <br /> COUNTY RECEIVED <br /> T Greotness grows here, <br /> Corrective Action Statement SEP 0 8 2025 <br /> RE: August 19, 2025, inspection report ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES <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 /> Monica De Anda at(209)616-3063 or mdeanda@sjgov.org. <br /> Facility name: COSTCO WHOLESALE#658 Submit completed form to: <br /> Facility address: 3250 W GRANT LINE RD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID: 10146285 ATTN: MONICA DE ANDA <br /> PR0518288 1868 E HAZELTON AVENUE <br /> STOCKTON, CA 95205 <br /> Violation#47-2030008-Secondary containment installed after July 1,2003 is free of water. C <br /> 5C This violation was corrected ❑This violation will be corrected by(date): —yC'Oes LO y �ecI Q1 doo <br /> ❑ Supporting documents included <br /> Describe actions taken or will be taken to correct violation: �). <br /> F 91 STP 5UNID ys°na 0, tiNap QCkC ps"ca 1.i yRCO-e-d u�"e�h t"no\�1 <br /> 1,,»re +M°s'gictu C- I PaYeeded is elecnh At CA&A baty$ ;'-N. Ic Ws Q r Ck6j <br /> -Ke v\ v4i W-A�\'\eJ t�.��ce,�y c\N a o��ed -0,e be-k kun aF C1 i -S;j mp <br /> e. �v�e. IS;�e.s tiaa be,-e'^ uV�ct COPr-2,CAR l -, <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 />