Laserfiche WebLink
p.2 <br /> ban Joaquin county <br /> Environmental Health Department REGLI <br /> r/ <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 !/ <br /> E L <br /> Tele hone. (209)468-3420 Fax:(209)468-3433 Web:www.sigov.org/ehd <br /> AUG 2 6 2015 <br /> RE URN TO COMPLIANCE CERTIFICATION ENVIRONMENTAL. <br /> Wgyp+TN n;:pe.PT4Ac7NT <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)address <br /> the top of this form within 30 days of receipt of the Inspection Report. HSG 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 me associated with failing to comply by the above noted dates will be <br /> billed at the curr nt hourly rate. <br /> For this certificatio to be complete, the operator of the site must include; <br /> A statement documen ng what corrective actions were taken or will be taken for each violation <br /> Copies of sample results/manifestsltraining records/other appropriate paperwork, and/or photos verifying corrections <br /> Inspection Date: August 13, 2015 Inspected By: FATINAH ZAREEF <br /> Facility Address: 1403,W COUNTRY CLUB BLVD, STOCKTOI 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 inspection date. <br /> 2. I have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION <br /> I believe the information to be true, accurate, a7paperwork <br /> coplete: <br /> Photos Statement <br /> 3. 1 am authorized to subfnit this certification on behalf of the Respondent. <br /> 4. 1 am aware that there are significant penalties far submitting false information. including the possibility of a fine andl <br /> imprisonment for known violations. (HSC 25191) <br /> Name: 7 �� �.. �/ 11 -� , r D % Title: <br /> Signature: — Date, <br /> �'2b �I� <br />