COMPLIANCE INFO 2004-2007 - Laserfiche WebLink

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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 Last Main Street,Stockton,CA 95202-3029 Telephone.; (209)468-3420 Feet:(209)468-3433 Web,www,sjgQy,�rGlehd RETURN TO COMPLIANCE CERTIFICATION Any MINOR violations noted in the"Notice to Comply` in the attached inspection report must be corrected within 30 days of receipt of this inspection. This certification form must be submitted to the Environmental Health Department(EHD) address at the top of this form within 35 days of receipt of the inspection report. All corrections to other vialations noted in the attached Inspection Report (IR)or Continuation Form, or disputes to any violations, are to be submitted using this certification and returned to EHD within 60 day_, unless otherwise specified in the IR. For this certification t0 be c02"I1plete the operator of the site must include: • A statement documenting what corrective actions were taken or will be taken for each violation • Copies of sample results/manifests/training records/other appropriate paperwork,and/or photos verifying corrections • Operator's certification --- .. ... __............. Inspection Date:..,F='_-E `��- - - - Inspected By: ii Facility Address: V" -`= =-'' rot - G I::iFft II)1r..,t_•,n I certify under penalty of law that: I i I 1, f have corrected the violations spcctfied in the Inspection Report ti'otn the above-mcntioned j inspection date. i 2. 1 have personally examined the; hollowing documentation submitted as proof of compliance FOR EACH VIOLATION and 1 believe the inf<Vnnation to he true, accurate, and complete: Photos ", _.Paperwork . s P Statement 3. tam authorized to subtrtit this certification on behalf of'thc Respondent. f 4. I am aware that there are significant penal ties fi)r submitting false information, including the possibility of a fine and/or jynpri ottment for known violations. (HSC 25191) Si pature, ",`bit r' >"l<, Date: G � 4� EHD 22-02-005 Rev 05/07