Laserfiche WebLink
10/18/2013 12:11 2093344684 <br />#5446 P.002 /004 <br />RE4-'&klVEZLj <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, Cal'rfomia 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www_s' ov.or hd <br />RETURN TO COMPLIANCE CERTIFICATION <br />OCT 18 2013 <br />SAN JOAQU N COUNTY <br />ENVIRONMENTAL <br />Any MINOR violations noted in the "Notice to Compiy' in the attached Inspection Report must be <br />corrected within 30 days of receipt of this inspection. This Certification form 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 Deport. HSC 25404.1_2(c)(1) <br />All .92rrectiQns to other violations noted in the attached Ins <br />pection IR) or Continuation Form, or <br />disputes to any violations, are to be submitted using this certification sand retturned to EHI) wiihf ,s <br />unless otherwise specified in the 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 <br />verifying corrections <br />• Operator's Certification <br />Inspection Date: October 2, 2013 Inspected By: Garrett Backus <br />Facility Address: 4315 E Waterloo Road EPA ID#: <br />I certify under penalty of law that: <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 d entation submitted a roof of compliance FOR <br />EACH VIOLATION and I believe the info on to be true, accur , and complete: <br />Photos paperwork Statement <br />3. 1 am auth " ed to submit this certification on behalf of the Respondent. <br />4. 1 am ware th there are significant natties for submitting false information, including the <br />possibility o fine and/or imprison <br />imprison t for wn A(Aations. (HSC 25191) <br />Name: L <br />Ac Title: <br />EHD 22-02-005 Rev 04119112 <br />