Laserfiche WebLink
SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax, (209) 468-3433 Web-.- -www.siQov.o[g/ehd <br />Any MINOR 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 />'Environmental Health Department (EHD) address at the top of this form within 30 days of receipt of the <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 30 day <br />unless otherwise specified in the Inspection Report. <br />Note: All EHD staff time associated with failing to comply by the above noted dates will <br />billed at the current •1. <br />For this cercation to be completethe operator of the site must include: <br />• A statement documenting what corrective actions were 1aken, or will betaken for each violatio <br />• Copies of sample results/manifests/training records/other appropriate paperwork, and/or phot <br />verifying corrections I <br />UKN*61� reliprilgi (I i5T-1 <br />EMEMMMII <br />1;F,Ml1MFx1,Rr= <br />11"TWIT-N <br />Inspected By: <br />1. 1 have corrected the violations specified in the Inspection Report from the above-mentioned <br />inspection date. <br />M::F_AX*]'WW9J W -All LOU, W9 stem 061 REA415 1- _111offe <br />.iel 11#11;:It <br />Photos Paperwork Statement <br />;�111111' ijl��11� 'I ��• 10 =- <br />4. 1 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 />71M M <br />EHD 22-02-005 Rev 08/08 <br />no <br />