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COMPLIANCE INFO
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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DR MARTIN LUTHER KING JR
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2200 - Hazardous Waste Program
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PR0523891
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COMPLIANCE INFO
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Entry Properties
Last modified
12/5/2018 10:44:08 AM
Creation date
10/31/2018 3:34:59 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2200 - Hazardous Waste Program
File Section
COMPLIANCE INFO
RECORD_ID
PR0523891
PE
2220
FACILITY_ID
FA0014723
FACILITY_NAME
White Hawk, Inc.
STREET_NUMBER
2101
Direction
E
STREET_NAME
DR MARTIN LUTHER KING JR
STREET_TYPE
BLVD
City
STOCKTON
Zip
95205
APN
15514003
CURRENT_STATUS
01
SITE_LOCATION
2101 E DR MARTIN LUTHER KING JR BLVD
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\D\DR MARTIN LUTHER KING JR\2101\PR0523891\COMPLIANCE INFO 2005 - 2013.PDF
QuestysFileName
COMPLIANCE INFO 2005 - 2013
QuestysRecordDate
7/12/2017 10:14:19 PM
QuestysRecordID
3499760
QuestysRecordType
12
QuestysStateID
1
Tags
EHD - Public
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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue,3"Floor,Stockton,CA 95202-2708 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www sieov.ore/ehd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in 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 60 days <br /> unless otherwise specified in the IR. <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 records/other appropriate paperwork, and/or photos N <br /> verifying corrections Re t2 <br /> • Operator's certification m Z���Zo 13 <br /> Inspection Date: Ice k all Inc j �3 Inspected By: <br /> n <br /> Facility Address: Z./0/ t�•Chc r}e r- 11,�r< EPA ID#: C/�LOirIDL. 3$'272, <br /> I certify under penalty of law that: <br /> 1. I have corrected the violations specified in the Inspection Report from the above-mentioned <br /> inspection date. <br /> 2. I have personally examined the following documentation submitted as proof of compliance FOR <br /> EACH VIOLATION and I believe the information to be true, accurate, and complete: <br /> Photos_VPaperwork_Statement <br /> 3. I 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 <br /> possibility of a fine and/or imprisonment for known violations. (HSC 25191) <br /> Name: Fefrvl ' y /kjZc. Title: (7 Cy/ e✓ IGbtst�c•� <br /> Signature: /fig. Date: 3 <br /> EHD 22-02-005 Rev 12-04 <br />
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