Laserfiche WebLink
Sep. 18. 2018 113P No. 2110 P. 2 <br /> Environmental Health Department <br /> SANJOA:Q.UIN. <br /> . `QED R RECEI <br /> 4 <br /> Graotnoas �r0ivs hcrc., <br /> RETURN TO COMPLIANCE CERTIFICATION SEP 18 2018 <br /> Any MINOR violations noted in the"Notice to Comply"In the attached Inspection Report must be corrected within 3o days of 'IMENTAL <br /> receipt of this irspectlon. This certification form must be submitted to the Environmental Health Department(EHO)address .'APARTMENT <br /> at the top of this form within 30 days of receipt of the Inspection Report. HSC 25404.1.2(c)(1) <br /> All corrections to other violations noted in the attached Inspection Report(IR)or Continuation Form,or disputes to any <br /> violations,are to be submitted using this certification and returned to EHD within 30 days unless otherwise specified In the <br /> Inspection Report. HSC 25185(c)(3) <br /> Note: All EHD staff time associated with failing to comply by the above noted date&will be <br /> billed at the current hourly rate. <br /> For this certification to be complete, the operator of the site most include: <br /> A statement documenting what corrective actions were taken or will be taken for each violation <br /> Copies of sample results/manifests/training records/other appropriate paperwork,and/or photos verifying <br /> corrections <br /> Operator's certiliCalion <br /> Inspection Date: _August 03, 2018 Inspected By: JAMIE LIMA <br /> Facility Address: 4520 EIGHT MILE RD, STOCKTON CERS ID: 10182013 <br /> 1 certify under penalty of law that: <br /> I_ I have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. <br /> 2. 1 have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION <br /> and I believe the information to be true,accurate, and complete, <br /> Photos Paperwork Statement <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4. 1 am aware that there are 4rilfcant penalties for submitting false information,including the possibility of a fine <br /> and/or Imprisonment for known violations. (MSC 25191) I <br /> Name: er� va iLaTitle: S1cYI% o►' Park Wbrke, <br /> Signature: Date: 1 - f 9 "1g <br /> 1868 E. Hazelton Avenue I Stockton,California 952051 T 209 468-3420 1 F 209 464.0138 1 www.sjcehd.com <br />