Laserfiche WebLink
1 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPART <br /> 600 East Main Street,Stockton,CA 95 0 -3029 <br /> Telephone:(209)468-3420 Fax:(209)4.68-3433 W www.S ov. ehd <br /> i <br /> RETURN TO C:OMPLIANCi 'CE IFI A f N <br /> :Any MINOR-violations noted in the"Notice to Comply"in the a Inspection Report must be <br /> 'corrected within 30 dam of receipt of this inspection. This certifica o form mus be submitted to the <br /> ;Environmental Health Department(END)address at the top of this o within 3 days of receipt of the <br /> :Inspection Report. <br /> 'All corrections to other violations noted in the attached Inspection a ort(1k)or ntinuation Form, or <br /> :disputes to any violations, are to be submitted uging this certlflc:atlo ,knd returne to EHD within 30 days <br /> unless otherwise specified in the Inspection Report. 1 <br /> :Note: All EHD staff time associated with failing to comply I y the abo fe noted dates will be <br /> 'billed at the current hourly rate. <br /> For this Certification to be Complete the opertc r of the site must Include: <br /> . A statement documenting what corrective actions were taken r Nill be takei I for each violation <br /> • Copies of sample results/manifests/training recordstother app riate paper York,and/or photos <br /> verifying corrections <br /> o <br /> Operator's esrtification <br /> Inspection Date: 2- 22--Or-/ Inspe By: /Ce ge rc� <br /> 'Facility Address: 7 Z� /" - T 0L G�31VCEPA 1 <br /> I certify under penalty of law that: <br /> 1. 1 have corrected the violations specified in the inspection R� rt from the above-mentioned <br /> inspection date. <br /> 2. 1 have personally examined the following documentation au�aitked as p of of compliance FOR <br /> EACH VIOLATION and I believe the information to be true,isi curate,anc complete: <br /> Photos Paperwork 1 Staterric nt <br /> 3. 1 am authorized to submit this certification on behalf of the !� pondent. <br /> 4. 1 am aware that there are significant penalties for submittinof Ose.inforrru tion, including the <br /> possibility of a One and/or imprisonment for known violation . (HSC•25t l) <br /> �1\ ` &J <br /> t2 LQ <br /> Signature: t �'`-c-�hal r Q Date: ' J_l <br />