Laserfiche WebLink
FIRMA ; T®:... olet...Reture-to:: ii:ance:::. .1.01 <br /> San Joaquin County HE(AdVED <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue,Stockton,California 95205-6232 <br /> Telephone.,(209)468.3420 Fax:(209)4$8-3433 Web.wwrw.sjGov.oro/ehd �NOV 19 2015 <br /> RETURN TO COMPLIANCE CERTIFICATIONENVIRONMENTAL <br /> W;:AITLJ d°R!1' <br /> Any MIbIQR violations noted in the"Notice to Comply"in the attached Inspection Report must be corrected within 30 daa 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. HSC 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 (�_,. a s unless otherwise specked in the <br /> Inspection Report, HSC 26185(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 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 results/manifests/training records/other appropriate paperwork,and/or photos verifying corrections <br /> Inspection Data: August 112015 Inspected By: FATI AH ZAREEF <br /> Facility Address: 6441 HOL MAN ISD, STOCKTON 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 /> a M-_ f..06—...,.. .i�.............4.+4t..... v.+4....14tved anv rravVf Vf VV.a/'.nil4glverlr f'VB't v/'lWl d V I�I1,./-11]WIN <br /> I believe the information tobe true, rate, and complete: <br /> Photos PaperworkStatement <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 and/ <br /> imprisonment for known violations. (FISC 25191) <br /> Name: Title: 56W, <br /> ! rad <br /> c <br /> Signature: _ Date: Z/ //6_ <br />