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SAN J O A Q U I N Environmental Health Department <br /> Corrective Action Statement <br /> RE: November 08, 2021, 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 /> Supervalu, 1990 N PICCOLI RD, CERS ID: 10181455, PR0231820 <br /> Violation#122-Failure to implement corrections and submit written response within 30 days of receiving the <br /> report. <br /> J9 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 violatiion: (9 <br /> Vl �c r v✓ � /_! ✓P.r <br /> _! f e'0 0 r�/I�! r/1 car z;j 6 i•tP eM 9 rl -7" &y( 7-A <br /> rte' /t/f0• <br /> Violation#203-Failure to maintain monitoring records for 36 months and maintenance records for 60 <br /> months. <br /> 8 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: r�//fd f fec' le <br /> /'c <br /> Violation#207-Failure to maintain designated operator inspection reports and all attachments on site for 36 <br /> months. ` <br /> J0 This violation was corrected IRThis violation will be corrected by(date). r��~ 26- <br /> 0 Supporting documents included <br /> Describe actions taken or will be taken to correct violation: /�t 41 c tq art � t <br /> I'le : <br /> Page 3 of 4 <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 />