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SANJOAQUIN Environmental Health Department <br />—COUNTY— <br />Greatness <br />--COUNTY--w— <br />Greatness grows here. <br />Corrective Action Statement <br />RE: August 31, 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 Vicky Vang-Lee at (209) 616-3028 or vvang-lee@sjgov.org. <br />Facility name: STOP N SHOP <br />Facility address: 1856 W COUNTRY CLUB BLVD <br />CERS ID: 10180831 <br />PR0231069 <br />Submit completed form to: <br />SJC ENVIRONMENTAL HEALTH DEPARTMENT <br />ATTN: VICKY YANG -LEE <br />1868 E HAZELTON AVENUE <br />STOCKTON, CA 95205 <br />Violation #101 - Failed to obtain a permit to operate from the EHD including but not limited to unpaid permit <br />fees. <br />iThis violation was corrected <br />❑ Supporting documents included <br />Describe actions taken or will be taken to <br />Ck_Q CAAc t - D� <br />❑ This violation will be corrected by (date): <br />violation: <br />Violation #102 - UST operating permit application for facility and tank information not submitted or current. <br />0( -This violation was corrected <br />❑ Supporting documents included <br />❑ This violation will be corrected by (date): <br />Describe actions taken or will be taken to correct violation: 4.7 W%k T <br />C 46R':; <br />Violation #105 - Failed to have an approved UST response plan. <br />Rev. 9/16/2020 <br />li!f' This violation was corrected <br />❑ Supporting documents included <br />❑ This violation will be corrected by (date): <br />Describe actions taken or will be taken to correct violation: -� V� IV V k � <br />a IQ <br />Page 2 of 7 <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 />