Laserfiche WebLink
JAN/29/2016/FRI 11:57 AM FAX No,b 003 <br />CEIVE <br />San Joaquin County <br />Environmental Health Department IAN 2 9 Z01 -h <br />1868 East Hazelton Avenue, Stockton, California 95205-6232 <br />?01�7 Telephone: (209) 468-3420 Fax., (209) 468-3433 Web: WWW- MNPD%W ' I I/L <br />HEALTH DEPARTMV <br />RETURN TO COMPLIANCE CERTIFICATION <br />Any MIN_QR violations noted in the"Notice to Comply" in the attached Inspection Report must be cotrec within 30 - of <br />receipt of this Inspection. This certification form must be submitted to the Environmental Health Department (EHD) address <br />at the top of this form within 30 days of receipt of the Inspection Report. HSC 26404.1.2(c)(1) <br />All corr s to othe'y1plations noted in the attached Inspection Report (IR) or Continuation Form, or disputes to any <br />violations, are to be submitted using this certification and returned to 51-11) within unless otherwise specified in the <br />Inspection Report. HSC 25185(c)(3) <br />'L . Ulm - <br />billed at the current 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/manffestsftraining records/other appnDpriate paperwork, and/Of Photos verifYWI <br />corrections <br />Inspection Date'. January 19, 2016 inspected By- CINDY VO <br />Facility Address-. 3330 N AD ART RD, STOCKTON EPA 10, <br />1. 1 have corrected the violations specified in the Inspection Report from thea mentioned inspection date. <br />2. 1 have personally examined the following documentation submitted as proof of compliance FOR 5ACH VIOLATIOP-1 <br />and I believe the information to be twe. accurate, and complete: <br />Photos P8PenNOrk, Statement <br />3. 1 am authorized to submit this certification on behalf of the Respondent <br />4. 1 am aware that there are significant penalties for submitting false infiormation, including the possibility of a fine <br />and/or impirlsonment for known violations. (HSC25191) <br />Title. <br />Signature: Datff. A rA C�-p (6 <br />It U <br />