Laserfiche WebLink
SAN J OA Q U I N Environmental Health Department <br /> .)u i%4 <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MIMOR violaUans noted in the'Notice to Comply`in the attached Inspection Report must be corrected within 30 days of <br /> receipt of this inspection. This certification form must be sutimdted to the Environmental Health Department(EHD)address at <br /> the batiom of this form within 30 days of receipt of the Inspecllon Report. HSC 254114.1.2(c)(1) <br /> All corrections to other%4ylaOons noted in the attached Inspei tion Report(IR)or Continuation Form.or dispulus to any <br /> violations,are to be submitted using this certification and returned to EtiD within 30 days unless otherwise specified in the <br /> Inspection Report_ HSG 25t85(cX3) <br /> Note: All EHD staff time associated with failing to comply by the above noted dates will be billed <br /> at the current hourly rate. <br /> For this certification to he complete, the operator or the site must include: <br /> A statement documenting what corrective actions were taken or will be taken for each violation <br /> Copies of sample resulWmanifestsltrairnng reoordslother appropriate paperwork,andlor photos ven ying corrections <br /> Operator's certification <br /> lnspection Date: May 18, 2024 Inspected By: FLIANNA FLORIDO <br /> Facility Address: 5354 PACIFIC AVE, STOCKTON DEng ID: 10835602 <br /> 1 certify under penalty of law that <br /> 1. 1 have corrected the violaWns specified in the Inspection Report from the above-mentioned inspection date. <br /> 2. 1 have personally examined the following docu enlalion submi as proof of compliance FOR EACH VIDLA7tON <br /> and I beliava the information to be true,a ate,and cam a: <br /> Photos PaP erwork L �SWrnnt <br /> 3. 1 am authorized to submit this certification on hahalf of the Respondent. <br /> 4_ 1 am aware that there are significant penalties for submitting false information.Including the possibility of a rine <br /> andlor lm rrsonmant for n violations. (HSC 25191) <br /> Name: r4 lk,. Title: <br /> Signature. Datta: o D <br /> Scanned with CamScan <br />