Laserfiche WebLink
9 SAN JOA UI COUNTY 0 <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />Te&phone: (209) 468-3420 Fax. (209) 468-3433 Web: www.sjgov.or_gLehd <br />Any MINO 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 />*f r­*w4yti664z_i <br />inspection report. <br />All corrections to other violations 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 60 dgys <br />unless otherwise specified in the IR. <br />For this certification to be completethe 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 />• Operator's certification <br />ffff=�� <br />"mums I ffm <br />I have corrected the violations specified in the Inspection Report from the above-mentioned <br />inspection date. <br />F"hotos Paperwork Statement <br />III <br />J <br />T. I 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: Title: <br />3= <br />EHD 22-02-005 Rev 05/07 <br />M <br />