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SAN : J 4 A Q U I N Environmental Health Department <br />COUNTY <br />jr Gre't,:,•tt gran, <br />Corrective Action Statement <br />RE: March 073 2022, Aboveground Petroleum Storage Act inspection report <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 <br />form with the Return to Compliance Certification within 30 days of inspection. If you have any questions, please <br />contact Carol Presto at (209) 616-3061 or cpresto@sjgov.org. <br />Facility name: SAFEWAY DISTRIBUTION CENTER <br />Facility address: 16900 W SCHULTE RD <br />'ERS ID: 10182289 <br />PR0528139 <br />Submit completed form to: <br />SJC ENVIRONMENTAL HEALTH DEPARTMENT <br />ATTN: CAROL PRESTO <br />1868 E HAZELTON AVENUE <br />STOCKTON, CA 95205 <br />Violation #604 -Plan failed to include oil type and storage capacity for each container. <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 />Violation #605 -Plan failed to include an adequate facility diagram, or no facility diagram was included. <br />❑ This violation was corrected <br />❑ documents included <br />❑ This violation will be corrected by (date): <br />Supporting <br />Describe actions taken or will be taken to correct violation: <br />Violation #619 -Failure to keep written records of procedures, inspections, and tests for at least three years. <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 />Page 2 of 5 <br />Rev. 9/16/2020 <br />1868 E. Hazelton Avenue � Stockton, California 95205 � T 209 468-3420 � F 209 464-0138 � www.sjgov.org/EHD <br />