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SQ N } 1 OAQ U I N Environmental Health Department <br />„ --_.COUNTY - - <br />r% Greotness 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 />STOP N SHOP, 1856 W COUNTRY CLUB BLVD, CERS ID: 10180831, PR0231069 <br />Violation #116 - Failure to submit the "Spill Container Testing Report Form" within 30 days after the test. <br />VThis violation was corrected ❑ This violation will be corrected by (date): <br />Supporting documents included ,, j <br />Describe action's +itaken or will be taken to correct violation: r/V� `�;�y� iltiQ�[�► <br />Violation #122 - Failure to implement corrections and submit written response within 30 days of receiving the <br />report. <br />his 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 />Violation #203 - Failure to maintain monitoring, maintenance, and follow up action records. <br />Rev. 9/16/2020 <br />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 <br />4"VIA Cn_ S4 <br />Page 5 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 />