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COMPLIANCE INFO_PRE 2019
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COMPLIANCE INFO_PRE 2019
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Entry Properties
Last modified
1/9/2019 11:35:52 AM
Creation date
11/1/2018 10:52:00 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2200 - Hazardous Waste Program
File Section
COMPLIANCE INFO_PRE 2019
FileName_PostFix
PRE 2019
RECORD_ID
PR0516192
PE
2220
FACILITY_ID
FA0012503
FACILITY_NAME
SAN JOAQUIN RIVER CLUB
STREET_NUMBER
30000
STREET_NAME
KASSON
STREET_TYPE
RD
City
TRACY
Zip
95376
APN
24115001
CURRENT_STATUS
01
SITE_LOCATION
30000 KASSON RD
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\K\KASSON\30000\PR0516192\COMPLIANCE INFO PRE 2016.PDF
QuestysFileName
COMPLIANCE INFO PRE 2016
QuestysRecordDate
3/11/2016 6:14:40 PM
QuestysRecordID
3029326
QuestysRecordType
12
QuestysStateID
1
Tags
EHD - Public
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r.J SAN JOAQUIN COUNTY RECEIVED <br /> y ED <br /> ENVIRONMENTAL HEALTH DEPARTMENT JAN 2011 <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209) 468-3420 Fax: (209)468-3433 Web:www.sogov.org/ehd <br /> ENVIRONMENTAL HEALTH <br /> PERMIT CES <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 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 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 recordslother appropriate paperwork, and/or photos <br /> verifying corrections <br /> • Operator's certification <br /> Inspection Date: - Inspected By: <br /> Facility Address: 2)00no 1� nT4)n i s EPA ID#: <br /> cck <br /> I certify under penalty of law that: <br /> 1. 1 have corrected the violations specified in the Inspection Report from the above-mentioned <br /> inspection date. <br /> 2. 1 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 /> 4 <br /> Name: i t er C. "br� C1 (A-1 U�irsL Title: NACSI f1*v)fitfl <br /> Signature: Date: l 4 <br /> EHD 22-02-005 Rev 10109 <br />
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