Laserfiche WebLink
SAN JOAQUIN COUNTY <br />ENviRONMENTAL HEALTH DEPARTMENT D <br />600 East Main Street, Stockton, CA 95202-3029 C E D <br />Telephone, (209) 468-3420 Fax. (209) 468-3433 Web.- www.sigov.org/etoPR 1 3 0110 <br />PEWAT/SERVICES <br />RETURN TO COMPLIANCE CERTIFICATION <br />I IT-ro 771 � r WE <br />Inspection Report. <br />All corrections to other violations noted in the attached Inspection Report (IR) or Continuation Form, or <br />disputes to anyviolations, are to be submitted using this certification and returned to EHD within 30 days <br />unless otherwise specified in the Inspection Report. <br />4ote: All EHD staff time associated with fang to comply by the above noted dates is <br />billed at the current hourly rate. <br />For this certification to be completethe 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/6ther appropriate paperwork, and/or photos <br />verifying corrections <br />• Operator's certification <br />Inspection Date: 9 — ;Z — /6 Ins pected By: R /N y <br />Facility Address: 1�i3 3 7-0 Lbc-tecolk(,-s� N- E PA 1 <br />TWIT3 <br />1. 1 have corrected the violations specified in the Inspection Report from the above-mentioned <br />inspection date. <br />oil 0 0 1 of # a 0 <br />41Lk1*AV*11Z4( <br />Photos Paperwork * Statement <br />authorized to submit this certification on behalf of the Respon#- <br />W 1 <br />e <br />WEE <br />EHD 22-02-005 Rev 10108 <br />