Laserfiche WebLink
SAN JOAQUIN Environmental Health Department <br />—COUNTY— <br />Greatness grows here. <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)sddress at <br />the bottom of this form within 30 days of receipt of the Inspection Report. HSC 25404.1.2(cx1) <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 />Forthis 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/manifes[sltraining records/other appropriate paperwork, and/or photos verifying corrections <br />Operator's certification <br />Inspection Date: August 09, 2019 Inspected By: CESAR RUVALCABA <br />Facility Address: 9550 N HWY 88, STOCKTON <br />I certify under penalty of law that: <br />CERS ID: 10181763 <br />1. 1 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 and <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. lam aware that there are significant penalties for submitting false information, including the possibility of a fine and/or <br />imprisonment for known violations. (HSC 25191) <br />Name: Title: <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />