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San Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, Califomia95205-6232 <br /> Telephone: (209)468-3420 Farr: (209) 468-3433 Web:www.sidov.oralehd <br /> Hazardous Materials Program Inspection Report <br /> Facility Name: Facility Address: Date: <br /> -ALIS GRILL & BAR#504 1 5756 PACIFIC AVE STOCKTON June 16 2015 <br /> Complete and submit a copy of the Return to Compliance Certification form to the EHD with a statement <br /> documenting the corrective actions that have been or will be taken for each violation, and any supporting <br /> paperwork, by 7/16/2015. <br /> Please be aware as of January 1, 2013, all businesses are required to submit all hazardous materials information <br /> online to the California Environmental Reporting System(CERS) at http://cers.calepa.ca.gov. Be sure to include <br /> your hazardous material activity in the Businesses Activities section in CERS in addition to any other relevant <br /> activities and required fields. <br /> Je4�d- flNLOiAC7- <br /> CHILI'S STOCKTON <br /> e"siq*Wath <br /> )S <br /> Caawrel Manager <br /> #504 <br /> ® 5756 Pacific Ave,Suite#95 <br /> Stockton, CA 95207 <br /> (209)474-9004 <br /> Fax: (209)474-0554 <br /> C00504@chilis.com <br /> ALL EHD STAFF TIME ASSOCIATED WITH FAILING TO COMPLY BY THE ABOVE NOTED DATES WILL BE BILLED AT THE CURRENT HOURLY RATE. <br /> THIS FACILITY IS SPBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE <br /> Received ByReceived By(printed name and title): Date: <br /> (signature): �� Jerry Martinez, Manage <br /> Inspector Inspector(printed name and title): Inspector Phone: <br /> (signature): NICHOLAS LOEHRER, HM Specialist (209) 468-0623 <br /> Page 3 of 3 <br />