Laserfiche WebLink
Jan. 25.2018 5:53PM Delta Growers No, 0073 P. 1 <br />San Joaquin County R ECO' FV E D <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, California 95205-6232 lk]\i 2 5 2018 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web. www.sjgov.org/ehd <br />RETURN TO COMPLIANCE CERTIFICATION ENVIRONMENTAL HEALTH <br />DEPARTMENT <br />Any MINA violations noted in the "Notice to Comply' in the attached Inspection Report must be corrected within 30 days 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 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 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 be taken for each violation <br />Copies of sample results/manifests/training recordslother appropriate paperwork, and/or photos verifying corrections <br />Inspection Date: January 02, 2018 Inspected By: ROBERT LOPEZ <br />Facility Address: 1310 W CHARTER WAY, STOCKTON CERS ID: 10187573 <br />I certify under penalty of law that: <br />1. 1 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. ,a <br />Photos V 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: 1\� D Title: <br />Signature: Date:- <br />