Laserfiche WebLink
0 UN JOAQU114 COUNTY <br /> ENVIRONMENTAL HEA I-TH DEPARTMENT <br /> 6&j Easr Main Street, Stockton, CA 95202-3029 <br /> (?G9)468-3420 Fax: (209)468-3433 Web:WWw.s'qov.orq/ehd <br /> TO COMPLIANCE CERTIFICATION <br /> Any i-,i.iNOR r oted ne "Notice to Comply" in the attached Inspection RepcFL must be <br /> corr--_,-d v.,:, -iri of this inspection. This certification form must be submitted to the <br /> Envirorli,nertal H--a',in Dep,Ornant '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\JJntionc;, are to be submitted using this, certification and returned to EHD within 30 days <br /> unless oth-;;rA`se specified i,� the Insrc,,;tion Report. <br /> Note: X! �IHP _,itaf" tirne assonlated with failing to comply by the above noted dates will be <br /> : filer ate ($105), <br /> cLirni:nt hi-mrly r <br /> Fol,- Itc be complete the operator of the site must include: <br /> ' ­ _. ; <br /> • <br /> A umeriLir-c, what corrective actions were taken or will be taken for each violation <br /> an le raqljltslii, iniiests/training records/other appropriate paperwork, and/c, photos <br /> peratc,,',s cer"`icction <br /> Inspection Date: Inspected By: <br /> VON r <br /> Facility Addre .E�* 6P-bA . EPA I D#: <br /> -4N <br /> I certify ij[id--,L,- pity of law that. <br /> 1. I --Y. :.O vitiations specified in the Inspection Report from the above-mentioned <br /> 2. ih -)ed the following documentation submitted as proof of compliance FOR <br /> a ri,4 <br /> believe the information to be true, accurate, and complete: <br /> --v-lhc)tos -Paperwork Statement <br /> ,.1 -31-1 �,,,brn;t tivs cerlification on behalf of the Respondent. <br /> I' am alv2 ,: that trip.:-e are significz.nt penalties for submitting false information, including the <br /> possibility of a fine and/or imprisonment for known violations. (HSC 25191) <br /> Name- Title: 5-V C-i K-,6, <br /> ,jr, <br /> Signaf-Ire- <br /> Date: <br /> EHE 22- )05, <br />