Laserfiche WebLink
• • AECEiVE <br /> • San Joaquin County JUL 2 9 2015 <br /> Environmental Health Department b <br /> Iv <br /> 1868 East Hazelton Avenue,Stockton, California 95205232 ` VIl1VNI QI <br /> Telephone:(209)468.3420 Fax:(209)468-3433 Web:www. ,, zr,�� oca T <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINQ violations noted in the"Notice to Comply"in the attached Inspection Report must be corroded within of <br /> receipt of this inspection. This certification form must be submMed to the Environmental Health Department(EHb)address, <br /> the top of this form within 30 days of receipt of the Inspection Report. HSC 25d04.1.2(c)(1) <br /> All corrections to other violations noted In the attached Inspection Report(IR) or Continuation r=orm, Or disputes t0 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(0)(3) <br /> Notre; All EHD staff time associated with failing to comply by the above noted dates will be <br /> billed at the current hourly rate, <br /> For this certification to be complete, the operator of the site must include: <br /> A statement documenting what corrective actions were taken or will betaken for each viotatlon <br /> Copies of sample resultsfmanifests/training recordslather appropriate paperwork, and/or photos verifying corrections <br /> Inspection Date: June 30 2015 Inspected By: PETER LOMBARDI <br /> i <br /> Facility Address: 1488 HULSLY WAY, MANTECA _ EPA ID: <br /> I certify under penalty of law that: <br /> 1. 1 have corrected the violations specified in the Inspection Report from the above-mentioned inspedpon date. <br /> 2. 1 have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION <br /> and 1 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 significant penalties for submitting false information, including the possibility of a fine <br /> and/or imprisonment for known violations. (HSC 25191) <br /> Name: <br /> !°Z-kl ePlr Title: 6707?,41_ r V-_W <br /> 7 <br /> Signature: Date: 7f21 r�5'_ <br /> LO/T0 39Vd b6SL# S3JGC 06TLSZ860ZT SS:ZZ STOZ/8Z/L0 <br />