Laserfiche WebLink
N 0 N n 12 20 01:49p P.1 <br /> M <br /> S7, 1 <br /> N 006/11/2020 4:24 PH FAX 7023419966 A 0901/10008 <br /> Environmental Health Department <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> AnyMINOR violations noted in the "Notice to Comply' in the attached Inspection Report must be corrected within 30 daysof <br /> receipt of this inspection. This certification form must be submitted to the Environmental Health Department(EHD)address at <br /> the bottom of this form within 30 days of receipt of the Inspection Report. HSC 25404.1,2(c)(1) <br /> All corrections to other vigQlations;noted in the attached Inspection Report(IR) or Contnuation Form,or disputes to any <br /> Viola,bons, 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 billed , <br /> 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 resulWmanifestsitraining records/other appropriate paperwork,and/or photos verifying corrections <br /> Operator's certification <br /> Inspection Date: March 30, 2020 Inspected By; PAUL NSO <br /> Facility Address: 7906 N EL DORADO ST, STOCKT(DN CERS ID: 10181259 <br /> 1 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 /> and I believe The information to be true, accurate,and complete: <br /> Photos Paperwork complete: /' <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 <br /> and/or im 1lsonment for known violations. (HSC 25191) <br /> Name: 0 N1, Title:- <br /> Signature: Date: <br /> 2 <br /> rR E C E I'Vi"11 [7 <br /> JUN 12 2020 <br /> 1 RONM ENTA L HEALTH <br /> PERMIT/SERVICES <br /> Received Time Jun. 12, 2020 2: 334PM No. 6032 <br />