Laserfiche WebLink
07/11/2011 22:04 2099838084 PAGE 02 <br />t r SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />boo F- Main St, Stockton, CA 95202-3029 <br />TdVhone.. (209) 468-3420,Fax.. (209) 468-3433 Web. www.qjg2y.oridehd <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. 'Ibis certification form must be submitted to the <br />Environmental. Health Department (EHD) address at the top of this form within 35 days of receipt of the <br />Inspection Report. <br />All co 'ons to othar viol ons noted in the attached Inspection Report or Continuation Form, or <br />disputes to any violations, are to be submitted using this certification and returned to EHD within 30 days- <br />unless <br />amunless otherwise specified in the Inspection Report. <br />Note: All EHD staff time associated with failing to comply by the above noted dates will be billed at <br />the current hourly rate ($A. ff iLz,A <br />For this certification t0 be complete the operator of the site must include: <br />• A statement documenting what corrective actions were taken or will be taken for each violation <br />• Copies of sample results/manifests/training records/other appropriate paperwork, anchor photos <br />verifying corrections <br />• t?nemtnr'4 certification <br />Inspection !'< , <br />Facility • r U06iso <br />I certify under penalty of law that: <br />l . I have corrected the violations specified in the Inspection Report from the above-mentioned <br />inspection date. <br />2. I have personally examined the following documentation submitted as proof of compliance FOR <br />EACH VIOLATION and I believe the information to be true, accurate, and complete: <br />Photos PaperworkStatement <br />3. I amt authorized to submit this certification on behalf of the Respondent. <br />4. I am aware that there are significant penalties for submitting false inforrxatation, including the <br />possibility of a fine and/or imprisonment for known violations. (HSC 25191) <br />Date: 7 1 I -Z-0 l / <br />