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J <br />L <br />o u i <br />E N N <br />San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, California 95205-6232 <br />Telephone., (209) 468-3420 Fax: (209) 468-3433 Web; www.Ajgov.oLgjChd <br />4 W11 i I I <br />1 :4 4 1-11- 11 <br />Inspection Report. HSC 25185(c)(3) <br />Note: All EliD staiN Ume associa V7ffiffing Is Mff.A'il <br />Wed Wiiri To Com <br />billed at the cuffent hourly rate. <br />For this certification to 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/n-anifests/training recordsiother appropriate paperwork, and/or photos verifying <br />corrections <br />operators certification <br />Inspection Date: September 23, 2013 Inspected By: Elena Manzo <br />Facility Address: 2072 W YOSEMITE AVE <br />CERS ID: 10181669 <br />1. [have corrected the violations specifiM in the Inspection Report from theabove-mentioned inspection date. <br />2. 1 have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION <br />and I believe the information to be true, accurate, and complete: <br />Photos paperwork Statement <br />3, 1 am authorized to submit this certification on behalf of the Respondent <br />4. lam aware that there are significant penalties for submitting false information, including the possibility of a fine <br />and/or imprisonment for known violations. (HSC 25191) <br />Ttle:— � &�Wcx—, <br />e�' — /—) <br />Pate, - 7 --& <br />t,'d 00L9VZ860Z do4SNoinb d 1,0: 60 L 4 90 inr <br />