Laserfiche WebLink
08/04/2015 08:48 5106544 QUIK STOP MAKS PAGE 03/10 <br /> San Joaquin County <br /> Environmental Health Department 4EGEr �/� <br /> EL <br /> 1868 East Hazelton Avenue, Stockton, Califomia95205-6232 <br /> Telephone:(209)468-3420 For. (209)468-3433 Wed:wwwsigov.o�ir /ehd <br /> AUG 04 2015 <br /> RETURN TO COMPLIANCE CERTIFICATION,NViRONMENTgt, <br /> Any MINOR violations noted in the"Notice to Comply"in the attached Inspection Report must be corrected witAin 30 dabs of <br /> receipt of this Inspection. This certification form must be submitted to the Environmental Health Department(EHD)address <br /> the top of this form Wdhin30 days of receipt of the Inspection Report. HSC 25404.1.2(c)(1) <br /> All correctlons 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 EHDwfthin 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 dates will be <br /> billed at the current hourly rate. <br /> For this certification to be complete, the operatorof the site must include: <br /> A statement documenting what corrective actions were taken orwill be taken for each violation <br /> Copies of sample results/manifests(training recordstother appropriate paperwork, and/or photos verifying corrections <br /> Inspection Date: July 09, 2015 - Inspected By: NICHOLAS LOEHRER <br /> Facility Address: 505 N MAIN ST, MANTECA EPA IU <br /> I certify under penalty of law that; <br /> 1. 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 /> 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 significant penalties for submitting false information,including the possibility of a fine andr <br /> imprisonment for known violations. (HSC 25191) <br /> Name: A,,9ti 6-TL_ OA r Title: �tn rc r CF C:7%/✓%,ao,Uu&1rA,. ns <br /> Signature: <br /> Date: S 3 I <br />