COMPLIANCE INFO_2006-2015 - Laserfiche WebLink

Home Browse Search

ME SAN JOAQUIN CO UNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, CA 95202-3029 Telephone: (209) 468-3420 Fax. (209) 468-3433 Web: www.sigov.org/ehd "OkETURN TO COMPLIANCE CERTIFICATION 0 Any MINOR violations noted in the "Notice to Comply" in the attached Inspection Report must be corrected within 30 days of receipt of this inspection. This certification form must be submitted to the Environmental Health Department (EHD) address at the top of this form within 30 days of receipt of the Inspection Report. All corrections to other violations " noted in the attached Inspection Report (IR) or Continuation Form, or disputes to any violations, are to be submitted using this certification and returned to EHD within 30 days unless otherwise specified in the Inspection Report. Note: All EHD staff time associated with failing to comply by the above noted dates will bZ billed at the current hourly rate. For this certification to be completethe operator of the site must include: • A statement documenting what corrective actions were taken or will be taken for each violation • Copies of sample results/manifests/training records/other appropriate paperwork, and/or photos verifying corrections Z_T1 I n .nspection Date: -7j Inspected By: I Facility Address: f j EPA ID#: 1,001 Z-!11hrL_41_D I certify under penalty of law that: 1. 1 have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. 11W hjvj jjWajajl� @=jWG1jWW IT&a nar, M 9,001 - ILTA 01111WAIN 0010 OMNI I *7-q W3 WW Photos -Paperwork _�_Statement 3. 1 am authorized to submit this certification on behalf of the Respondent. 4. 1 am aware that there are significant penalties for submitting false information, including the possibility of a fine and/or imprisonment for known violations. (HSC 25191) K__11 Marm EHD 22-02-005 Rev 08108