Laserfiche WebLink
'Apr. 23. 2010 " 4:46PV K/P CORPORTION <br /> ' -No. 5448P. 1 '"'-- <br /> .y <br /> SAN JSAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Strtet,Stockton, CA 95202-3029 v® <br /> Telephone:(209)466-3420 Fak:(209)468-3433 Web:www.s'uov.org/eh ��APR 2 3 2010 <br /> EN q." V COUNne <br /> RETURN TO COMPLIANCE CERTIFICATION "F4'tt'13 P;-9TMENr <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 30 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 <br /> billed at the current hourly rate. <br /> For this certification t0 be CORlplete 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/manirests/training records/other appropriate paperwork, and/or photos <br /> verifying corrections <br /> • Operator's certification <br /> Inspection Date: --a4 ` Inspected By: RQC-Tr 94_' K06 <br /> Facility Address: i ( 4 ek"MMIfMtf- EPA ID#: C%kL Do0 ;Z&I_-tq I <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 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 <br /> possibility of a fine and/or imprisonment for known violations. (HSC 25191) <br /> Name: f"b1 P.,Ff 'ft l�oaJ61 Title: 0W1V6_R I5 Wr r—& <br /> Signature: �'�^��' �� Date: 3-a3- <br /> 301 <br />