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S A NJOQ Q U N Environmental Health Department <br /> COUNTY <br /> Greatness grown }, ,, , <br /> Corrective Action Statement <br /> RE : May 07 , 2020 , Underground Storage Tank 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 Shewit Woldearegay at (209 ) 468-0216 or stwoldearegay@sjgov. org . <br /> Facility name : Costco Wholesale # 1031 Submit completed form to : <br /> Facility address : 2440 DANIELS ST SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : 10146143 ATTN : SHEWIT WOLDEAREGAY <br /> PR0527629 1868 E HAZELTON AVENUE <br /> STOCKTON , CA 95205 <br /> Violation # 103 - Failure to submit and maintain complete and current financial responsibility documents . <br /> �I This violation was corrected ❑ This violation will be corrected by ( date) : <br /> ❑ Supporting documents included <br /> Describe actions taken or will be taken to r.:orrect violation : <br /> /-\X� � <br /> t►.ltd CC �Ci �ixy�►-1� c�� r`�� ►fin l`b ► L � . �� n <br /> Violation #316 - Secondary containment not constructed to prevent water intrusion (after Jul 2003 ) . <br /> �E] 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 : T " V I c)t� l.Je2o; <br /> � rl ��l✓ ��� rY1 � �V 1C.� C��'.^ 1STiC�'1 t.Si ?Lary11 CJ'1 .. <br /> CkSe�e i1 V EZ <br /> MAY 15 2020 <br /> ENVIRONMENTAL HEALTH <br /> PERMIT / SERVICES <br /> Rev. 8/27/2019 Page 2 of 2 <br /> 1868 E . Hazelton Avenue Stockton , California 95205 1 T 209 468 -3420 1 F 209 464 -0138 I www . sjcehd . com <br />