Laserfiche WebLink
Fttlff To:: e__ rolet.Return+to Colpl1ance:::Anention :<. . 14.2011/191-15 ET Pg. _.2-20... <br /> San Joaquin County <br /> Environmental Health Department HVED <br /> 1868 East Hazelton Avenue,Stockton,California 95205-6232 <br /> Telephone.(209)468-3420 :(209)468-3433 Web:www.sigQy,prg1eehhd NOV 19 2015 <br /> RETURN TO COMPLIANCE CERTIFICATION ENVIRONMENTAL <br /> LAZAITU nCo13ARPNIT <br /> Any MINO. violations noted to the"Notice to Comply"in the attached Inspection Report must be S^,orrected Within 30days of <br /> receipt of this inspection. This certification form roust 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 v.�jj b $D a s 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 <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 late: _August 112015 Inspected Ey: FATiNAH ZAREEF <br /> Facility Address: 6441 HOLMAN RD, STOCKTON EPA Ila: <br /> l 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 /> n l 4........ p......as..tly. _.._.__: d 6,-_ Pr!!_..:..� .d..............a.atv..vv,r.ea6tvJ--;✓e v�.P of vv,n�.+,1s.q,evV.—.1 —Alall i V BV I]WIN <br /> !believe the information to:etrue,�rat_e, and complefe:os Paperwork Statement <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. (HSC 25191) <br /> N a m e: Td1e: 56W,L65 <br /> Signature: Date: / <br />