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San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, California95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sigov.orq/ehd <br />Hazardous Materials Program Inspection Report <br />Facility Nasse: <br />Facility Address: <br />Date: <br /><ENTUCKY r=RIED CHICKEN <br />1455 PACIFIC AVE. STOCKTON <br />Juni: 19 201' <br />Overall Inspection Comments: <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 7/19/2015. <br />Please be aware as of January 1; 2013, all businesses are required to submit all hazardous materials informatio <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 />ALL EHD STAFF TIME ASSOCIATED WITH FAILING TO COMPLY BY THE ABOVE NOTED DATES WILL BE BILLED AT THE CURRENT HOURLY RATE. <br />THIS/F CILITY SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE <br />Received By rr <br />Received By (printed name and title): <br />Manager <br />Date: <br />t-/15 <br />(signature): <br />Randv Leingang. <br />Inspector - <br />Inspector (printed name and title): <br />Ins or hone: <br />(signature): <br />NICHOLAS LOEHRER, HIM Specialist 1 <br />(209) 468-0623 <br />Page 2 of 2 <br />