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Environmental Health Department <br /> SAN : J OAQU I N <br /> COUNTY <br /> Corrective Action Statement <br /> RE : August 16 , 2023 , 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) 616-3063 or stwoldearegay@sjgov. org . <br /> Facility name : COSTCO WHOLESALE #658 Submit completed form to : <br /> Facility address : 3250 W GRANT LINE RD SJC ENVIRONMENTAL HEALTH DEPARTMENT <br /> CERS ID : 10146285 ATTN : SHEWIT WOLDEAREGAY <br /> PR0518288 1868 E HAZELTON AVENUE <br /> STOCKTON , CA 95205 <br /> Violation #113 - Failure to conduct secondary containment testing . <br /> i[X 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 : <br /> All necessary precautions will be taken to ensure testing is performed in a timely manner . <br /> Violation #115 - Failure to submit " Monitoring System Certification Form" within 30 days of completion of the <br /> test. <br /> M 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 : <br /> All necessary precautions will be taken to ensure testing and testing submittals are <br /> Violation #117 - Failed to submit "Secondary Containment Testing Report Form " within 30 days after the test. <br /> M 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 : <br /> All necessary precautions will be taken to ensure testing and testing submittals are <br /> Page 2 of 3 <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 />