Laserfiche WebLink
002454 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTIi DEPARTMENT <br /> 600 East Main Street,Stockton, CA 95202-3029 <br /> Tolep:?ona:(209)468-3420 Fax:(209)468.3433 Web:wvv`er.s' ov_:orgrehd <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 farm 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 I <br /> billed at the current hourly rata. <br /> For this certification t0 be cUfl plete 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 /> • <br /> Operator's certification <br /> Inspection Date: /0 '�b W3 Inspected By, 4,;.s eeq C, rfi <br /> Facility Address: lilt E• ke-N-1t[". Wheilu)%GAEPA ID#: <br /> I <br /> 1 certify under penalty of loot that: <br /> I <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 /> j 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 i <br /> possibility of a fine and/or imprisonment for known violations. (HSC 25191) <br /> Y <br /> Name: �Q 2e n �,n Title: <br /> Signature �'� Date- <br /> : /3 <br /> i <br /> EHe 22-07.•005 Hev 08106 ' <br />