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SAN J D A Q U I N Environmental Health Department <br />f COUNTY <br />- Grey{n�rs 9r�14' �� <br />Corrective Action Statement <br />RE: November 08, 2022, 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. 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 Frederick Ernest at (209) 616-3026 or fernest@sjgov.org. <br />Facility name: COSTCO WHOLESALE #658 <br />Facility address: 3250 W GRANT LINE RD <br />CERS ID: 10146285 <br />PR0518288 <br />Submit completed form to: <br />SJC ENVIRONMENTAL HEALTH DEPARTMENT <br />ATTN: FREDERICK ERNEST <br />1868 E HAZELTON AVENUE <br />STOCKTON, CA 95205 <br />Violation #111 - Failed to notify the EHD 48 hours prior to conducting testing. <br />JS) This violation was corrected ❑ This violation will be corrected by (date): <br />]8[ Supporting documents included <br />Describe actions taken or will be taken to correct violation: <br />Enclosed is a notification via email on August 17, 2022 from Jones Covey to Stacy Rivera <br />for the testing on 8/30 and 8/31 with a start time of 8AM. This is within the 48 -Hour <br />notification requirement. <br />Violation #115 - Failure to submit "Monitoring System Certification Form" within 30 days of completion of the <br />test. <br />j8) 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 />Enclosed is a revised Monitoring Certification from AIITech Petro, Inc. <br />Violation #118 - Failure to submit the "Overfill Prevention Equipment Inspection Report Form" within 30 days. <br />Rev. 9/16/2020 <br />R 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 precautions will be taken to ensure testing and submittal of test reports are performed in a <br />a timelv manner. <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 />