Laserfiche WebLink
SAN JOAQUIN COUNTY RECEIVE® <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 DEC 2 8 2011 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.s6gov.org/ehd <br />ENVIRO�NMEN�TAL. HEATH <br />— _ -- -- -- _-- - _ —�'E IRM T/SERVICES <br />RETURN TO COMPLIANCE CERTIFICATION <br />Any MINOR violations noted in the "Notice to Comply" 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 Report. HSC 25404.1.2(c)(1) <br />All corrections to other violations noted in the attached Inspection Report (IR) or Continuation Form, or <br />disputes to any vio ations, are to be submitted using this certification and returned to EHD within 30 days <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 hourlrate. <br />For this certification to Le 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 />e L)peraior s cerimcation <br />Inspection Date: December 22, 2011 Inspected By: Garrett Backus <br />Facility Address: 2929 Auto Center Circle <br />certify under penalty of law that: <br />EPA ID#: CAL000360705 <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 documentation submitted as proof of compliance FOR <br />EACH VIOLATION and I believe the information to be true, accurate, and complete: <br />X Photos A_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 <br />possibility of a fine and/or imprisonment for known violations. (HSC 25191) <br />Name: fly_ Title: POAS 11 iAnnS <br />iM %C.r•as\ E P_ -.►\k 2.Ar- Date: % 2--2-1- 1 <br />EHD 22-02-005 Rev 09/11 <br />