Laserfiche WebLink
09/29/2016 09:57 2093675424 BAGLEY ENTERPRISES PAGE <br />01/03 <br />CountySan Joaquin <br />Environmental YaDepartment <br />1868 East Hazallon Avenue, Stockton, California 9520"232 SEP 2 9 2016 <br />Telephone; (209 46 .f: ,., .. mah: <br />RETURN TO NCE � • } HEALTH <br />>s f. <br />DEPARTMENT <br />Any MINOR r r t 't in the 'Wice toComply"-r Inspection Report,, r <br />-awad within 30 dgys of <br />receipt r.:. inspection. This certification r.: must be submitted to the EnvironmentalDepartment (EHDaddress; <br />the top of this form within 30 days of receipt of the Inspection Report. HSC 25404.1.2(c)(1) <br />All correctioas #. ■ h-" vigWons noted in = attached Inspection <br />Report <br />.moi• .:. or <br />Continuation ■ or disputes to any <br />violations, are to be submitted using this certification and returned to EHD within-3-0-dw unless otherwise specified in the <br />Inspection ♦. <br />Note: All EHD staff time associated with Wing 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 />statement documenting what correctivet: - taken or will taken for♦ +. <br />Copies ofsample•tee ey t:' a ♦. records/other appropriatepaperwork, and/or photos y. corrections <br />Inspection Date: August 25, 2016 Inspected Sy: STACY RIVERA <br />Facility Address: Hospital R. French Camp_ EPA i'. <br />under penalty of <br />1. 1 have corrected <br />.• •-t: the violations specifiedin the Inspection Report from the above-mentioned inspection dale. <br />2. 1 have personally examined the following documentation submitted as proof of a •p - FOR EACH VIOLATION <br />and I believe the information to be true, accurate, and complete - <br />otos -____Yaperworkment <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 <br />andfor imprisonment for known violations. (HSC 25191) <br />Name: " l <br />Signature:. f Date: <br />