Laserfiche WebLink
0 SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web:www.sigov.org/ehd <br />Any MINOR violations noted in the "Notice to Comply" in the attached Inspection Report must be <br />correctedwithin 30 daysof, receipt of this inspection. - This- certification form must be submitted to the <br />Environmental Health Department (EHD) address at the top of this form within 30 days of receipt of the <br />Inspection Report. <br />All corrections to other violations noted in the attached Inspection Report (IR) or Continuation Form, or <br />disputes to any Violations, are to be submitted us7ing this certification and returned to EHD within 30 days <br />unless otherwise specified in the Inspection Report. <br />Note: All EH b staff time associated with failing to -comply by the above noted dates -will be <br />billed at the current hourly <br />For, this certification to. be complete the operator of t ' he 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, and/or photos <br />verifying corrections <br />• _Operator's certification, <br />EMEMMM <br />Inspected By: <br />EPA ID#: <br />I certifyr <br />under penalty of law that: <br />1. 1 have corrected the violations specified in the Inspection Report from the above-mentioned <br />Jnspection date. <br />_Mil UVUO fag jN91FIR-0 02[oloizoarar-M!�.. M1112010ki-11111 - <br />Photos Paperwork Statement <br />3. 1 am authorized to submit this certification on behalf of the Respondent. <br />Name: Title: <br />M� <br />EHD 22-02-005 Rev 10/09 <br />