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:aDepartment <br /> SANid0A0UIN ll C=� c`�; �� � 'i'dh <br /> `t =all COUNTY <br /> Greotness ro �4s- % here , <br /> Corrective Action Statement <br /> RE : June 09 , 2020 , Underground Storage Tank inspection reportI <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 /> Shewit Woldeareqay at (209) 468-0216 or stwoldearegay@sigov . org . <br /> Facility name : SAFEWAY FUEL CENTER #2600 Submit completed form to : <br /> Facility address : 1987 W ELEVENTH ST SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : 10156819 ATTN : SHEWIT WOLDEAREGAY <br /> PR0517565 1868 E HAZELTON AVENUE j <br /> STOCKTON , CA 95205 <br /> Violation #104 - UST operating permit application for facility and tank information not submitted or current. <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 correct overfill prevention equipment <br /> was uploaded in CERS on 6/9/2020 . <br /> Violation #215 - Failure to retain a copy of the permit to operate at the facility . <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 Current UST operating permit was <br /> emailed to the station on 6/ 10/2020 and will be filed in the Records Retention binder . <br /> Rev. 8/27/201 Page 2 of 2 <br /> 1868 E . Hazelton Avenue Stockton , California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www. sjcehd . com <br />