Laserfiche WebLink
T i ,w <br /> San Joaquin County <br /> Environmental Healln Department <br /> 1888 East Hazelton Avenue, Stockton, Califomia95205-8232 <br /> Telephone:(209) 468-3420 Fax: (209) 488-3433 Web:ww�v,,,�' Q_yg(ghq <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any jv_S,NQB violations noted in the`Notice to Comply"in the attached inspection Report must be of <br /> receipt of this inspection. This certification form must be submitted to the Environmental Heatth Departmenf{EHD)address <br /> the top of this form witbin30 days of receipt of the inspection Report HSC 25404.1 2(c)(1) <br /> All 44Lt i Fts�JQ­QgtIgr vi9Ln;((itts 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 END rf ut_Nunless otherwise specified in the <br /> inspection Report. HSC 25185(c)(3) <br /> (dote: 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 resuits/manifestsflraining records/other appropriate paperwork, andlor photos verifying corrections <br /> Inspection Date: April07, 201 Inspected By: i1f5EtI R I_i 1"U' <br /> Facility Address: 4943 S STATE: R1 99 Stockton EPA ID: ` <br /> I codify under penalty of law that: <br /> 1. I have corrected the violations specified in the Inspection Report from tile above-mentioned inspection date. <br /> 2 1 have personalty examined the following documentation submitted as proof of compliance FOR EACH VIOLATIO <br /> I believe the information to ba 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 rine and' <br /> imprisonment for known violations. (HSC 26191) <br /> Name s c � Titlec -a <br /> g 4t <br />