Laserfiche WebLink
SAN JOAQUIN Environmental Health Department <br /> L. <br /> 01,J U Pd I Y <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 he submitted to the Env,ronmenlal Health Department([_FID)address at <br /> the bottom 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(I R)or Continuation Form,or disputes to any <br /> violations,are to be submitted using this cedlfcadon and returned to LED 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 rosulalmanifestsltrotning records/other appropriate paperwork,and/or photos verifying corrections <br /> Operator's cedificatien <br /> Inspection Date: June 12, 2019 Inspected By: CESAR RUVALCABA <br /> Facility Address: 933 E EIGHTH ST, STOCKTON CERS ID: 10190999 <br /> I certify under penalty,of law that <br /> 1. 1 have carrecred the violations specified in the Inspection Report from the shove-mentioned inspection date. <br /> 2. 1 have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION and <br /> I believe the information to he true,accurate,and complete'. <br /> _Photos_Paootwork Statement <br /> 3. 1 am authorized to submit this certification on behalf alibi Respondent. j <br /> 4. 1 am aware Thal there are significant penalties for submitting false information,including the possibility of a fine mm?pi- <br /> imprisonment for known violations. (1-125191) <br /> Name:_===" � ..._. Title: 1r12,1W dJ2� X44 <br /> 1868 E Hazelton Avenue Starkloa, California 95205 i T 2094CR3420I F 209464-0130 1 www.ejestr nt <br />