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COMPLIANCE INFO 2013 -2016
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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2300 - Underground Storage Tank Program
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PR0231060
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COMPLIANCE INFO 2013 -2016
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Entry Properties
Last modified
7/6/2020 4:40:19 PM
Creation date
11/4/2018 3:20:07 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2013 -2016
RECORD_ID
PR0231060
PE
2361
FACILITY_ID
FA0003870
FACILITY_NAME
SRH FOOD & GAS
STREET_NUMBER
749
Direction
E
STREET_NAME
DR MARTIN LUTHER KING JR
STREET_TYPE
BLVD
City
STOCKTON
Zip
95206
APN
14734309
CURRENT_STATUS
01
SITE_LOCATION
749 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\749\PR0231060\COMPLIANCE INFO 2013 -2016 .PDF
QuestysFileName
COMPLIANCE INFO 2013 -2016
QuestysRecordDate
3/28/2018 9:47:52 PM
QuestysRecordID
3839038
QuestysRecordType
12
QuestysStateID
1
Tags
EHD - Public
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San Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 �� <br /> Telephone: (209)468-3420 Fax:(209)468-3433 Web:www.sigov.org/ehd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the"Notice to Comply" in the attached Inspection Report must be corrected within 30 days of <br /> receipt of this inspection. This certification form must be submitted to the Environmental Health Department(EHD)address; <br /> the top of this form within 30 days of receipt of the Inspection Report. HSC 25404.1.2(c)(1) <br /> All corrections to other violations noted in the attached Inspection Report (IR) or Continuation Form, or disputes to any <br /> violations, are to be submitted using this certification and returned to EHD within 30 days unless otherwise specified in the <br /> Inspection Report. HSC 25185(c)(3) <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 records/other appropriate paperwork, and/or photos verifying corrections <br /> Inspection Date: May 24, 2016 Inspected By: FATINAH ZAREEF <br /> Facility Address: 749 E DR MARTIN LUTHER KING JR BLVD EPA ID: <br /> I certify under penalty of law that: <br /> 1. I have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. <br /> 2. 1 have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION <br /> 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 possibility of a fine and/ <br /> imprisonment for known violations. (HSC 25191) <br /> Name: MU�AYhMcLj - 12i'Zu/AN Title: Wh)Q�' _ <br /> Signature: ytl Date: ALI-1/� <br />
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