Laserfiche WebLink
SAN JOAQUIN CoUNIY <br />ENMOWENrAL.HFAI rHDEPARrmENr <br />600 East Main street, Stockton, CA 95202-3029 <br />(209) 468••3420 Fax. (209) 468-3433 Web; www.sigov.ore%hd <br />TO COMPLIANCE CERTIFICATION <br />Any MINOR violations noted in the `Notice to Comply" in the attached Inspection Report must be <br />corrected within 30 da Of'receipt of this inspection.. This certification form must be submitted to the <br />Environmental Health epartment (EHD) address at the top of this form within 35 days of receipt of the <br />Inspection Repoit <br />All cOLrectiOns t0 Other 'olations noted in the attached Inspection Report (IR) or Continuation Form, or <br />disputes to any violations, are to be submitted using this certification and returned to EHD within.30 days <br />unless otherwise specified in the Inspection Report_ <br />Note: All EHD staff tie associated with failing to comply by the above noted dates will be billed at <br />the current hourly rate $122). <br />For this Certification to be complete the operator of the site must include: <br />• A statement do eating what corrective actions were taken or will betaken for each violation <br />• Copies of sample colts/manifests/training records/other appropriate paperwork, and/oi photos <br />verifying corrections <br />• Operator's ceitificlation <br />Inspection Date: 7K29/11 <br />Inspected By: -Jeffrey Wong <br />17471E Dr Martin Luther King <br />Facility Address; Stoc ton, CA 95205-7012 EPA ID#: CAD982496887 <br />I certify under• penalty �f law that: <br />L I have corrected the violations specified in the Inspection Report from the above-mentioned <br />inspection date <br />2. 1 have personally ex ed the following documentation submitted as proof of'compliance FOR <br />EACH VIOLATIO and I believe the information to be true, accurate, and complete: <br />Photos X Paperwork K Statement <br />3.. I am authorized to s+n1it this certification on behalf of the Respondent. <br />4. I am aware that there are significant penalties for submitting false information, including the <br />possibility of a fineand/OT imprisonment for known violations.. (HSC 2519 1) <br />Name: J oat 11 ---.----Title: Vice President G General <br />Date: September 1, 2011 <br />EHD 22-02-OOYM 08/10 <br />r <br />