Laserfiche WebLink
SAN J O A Q U I N Environmental Health Department <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR 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 /> at 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 tenth failing to comply by the above noted dates of EC <br /> billed at the current hourly rate. <br /> AUu222018 <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 NMENTAL HEALTH <br /> Copies of sample results/manifests/training records/other appropriate paperwork, and/or photos verif, \/IRO <br /> corrections DEPARTMENT <br /> Operator's certification <br /> Inspection Date: August 09, 2018 Inspected By: AARON HANG <br /> Facility Address: 1553 COLONY RD, RIPON CERS ID: 10184317 <br /> 1 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 submi d as proof of compliance FOR EACH VIOLATION <br /> and I believe the information to be true, accurate, and comp) e: <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 <br /> and/or impri ent for known violations. SC 25191) <br /> Name: Title: �U�Y Cnn-k�� /✓t�����/, <br /> Signature: Date: <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />