COMPLIANCE INFO_2005-2008 - Laserfiche WebLink

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SAN JOAQUIN COUNTY D ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street,Stockton,CA 95202-3029 AUG 2 0 2007 Telephone:( ww_ 209)468-3420 Fax:(209)468-3433 Web: w.siQov.org(ehd ENVIRONMENT HEALTH RETURN TO COMPLIANCE CERTIFICATION Any MINOR violations noted in the"Notice to Comply' in the attached inspection report must be cox,.ected within 30 days of receipt of this inspection. This certification form must be submitted to the Enviropi- ental Health Department (EHD) address at the top of this form within 35 days of.receipt of the inspection.report. All orrections to other violations noted in the attached Inspection Report(IR) or Continuation Form, or disp,Acs to any violations, are to be submitted using this certification and returned to EHD within 60 days unless othen vse snecified in the IR. For this, cerci-cation to be complete the operator of the site must include: A statement documenting what c;rrect ve actions were taken or will be taken for each violation Copies of sample resultsi'marxifests/trairiing records/other appropriate paperwork, and/or photos Vaxfying corrections Operator-s certification In s P ec t i o n talc: )ic- Zd'-- 2��'� Inspected By: I Eack'.Nty Address: a 7� j l �- L�c�� EPA ID#: 1 certify under penalty of law that: f (D I have corrected the violations specified in the Inspection Report from the above-mentioned i Lz?spection date. I I inave personally examined the following documentation submitted as proof of compliance FOR � ;EACH VIOLATION and 1 believe the information to be true, accurate, and complete: I � Photos Paperwork � Statement i � ?. am authorized to submit this certification on behalf of the Respondent. I 4. 1 and aware that there are significant penalties for submitting false information, including the possibility of fine and/or imprisonment for known violations. (HSC 25391) I I i I Name: L n/ j iwwtl Title: i i Signature: Date: EHD 22-02-005 Rev 05/07