Laserfiche WebLink
SAN JOAQUIN COUNTN' <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> b00 East(Main Street,Stockton.CA 95202-3029 <br /> Telephone.(209►468-3420 Fax.(209)468-3433 14e6:www.��gov.or�rhd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted to the:."Notice to Comply" in the attached Inspection Report must be <br /> corrected within 30 days of receipt of this inspection. This certification form must be submitted to the <br /> Environmental Health Department(EHD)address at the top of this form within 35 days of receipt of the; <br /> Inspection Report. <br /> All corrections to other violations noted in the attached Inspection Report(IR)or Continuation Form. or <br /> disputes to any violations, are to be submitted using this certification and returned to EHD within 30 days <br /> unless otherwise specified in the Inspection Report. <br /> Note: All EHD staff time associated with failing to comply by the above noted dates will be billed at <br /> the current hourly rate. <br /> For this Certification to be COMPICte the operator of the site must include: <br /> • A statement documenting what corrective actions were taken or will betaken for each violation <br /> • Copies of sample results/manifests/training records/other appropriate paperwork, and/or photos <br /> verifying corrections <br /> • Operator's certification <br /> Inspection Date: May 29, 2009 Inspected By: Ray Von Flu <br /> 1616 Boeing Way <br /> Facility Address:Stockton, CA 95206 EPA (D#: CAL 000 326774 <br /> I certify under penalty of law that: <br /> 1. l have corrected the violations specified in the Inspection Report from the above-mentioned <br /> inspection date. <br /> 2. l have personally examined the following documentation submitted as proof of compliance FOR <br /> EACH VIOLATION and 1 believe the information to be true, accurate, and complete: <br /> X Photos X Paperwork. _ X Statement <br /> 3. 1 ani authorized to submit this certification on behalf of the Respondent. <br /> 4. l am aware that there are significant penalties for submitting false infonnation, including the <br /> possibility of a tine and/or imprisonment for known violations. (HSC 25 191) <br /> Name: Tatsuo Ishida -Title: CEO / President <br /> Signature: � � � Date: June 22, 2009 <br /> EHD 22-02-005 Rev I 1/07 <br />