Laserfiche WebLink
11/25/2015 WED 11!22 FAX 2098704468 CerViCeAdminMFD r. '-a— <br />San Joaquin County ai= d GE environmental Health DepartmentI VEL <br />1868 East Hazelton Avenue, Stockton, California 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgoy�(ehd NOV 2i 5 201L <br />RETURN TO COMPLIANCE CERTIFICATION ENVIRONMENTAL <br />Any MINQB violations noted in the "Notice to Comply" in the attached Inspection Report must be correctgd wiUlh3ajaW of <br />receipt of this Inspection. This certification form must be submitted to the Environmental Health Department (EHL)) address <br />the top 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 (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 />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 verifying corrections <br />Inspection Date: July 20, 2015 Inspected By: FATINAH ZAREEF <br />Facility Address: 2929 AUTO CENTER CIR, STOCKTON EPA ID: CPLC�Q03� '_XF <br />I certify under penalty of law that: <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 <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, 1 am aware that there are significant penalties for submitting false information, including the possibility of a fine ands <br />imprisonment for known violations. (HSC 25191) <br />Name: C� A e- L r114 t-71 Fe Title: Pal-r_i On rALjA C�QC <br />Signature: Date: <br />