Laserfiche WebLink
SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMEO <br />600 East Main Street, Stockton, CA 95202-3029 <br />IN 51 <br />, TKITTOONA <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. This certification form must be submitted to the <br />Environmental Health Department (EHD) address at the top of this is within 30 days of receipt of th- <br />• • <br />pection 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 using this certification and returned to EHD within 30 days <br />unless otherwise specified in the Inspection Report. <br />Note: All EHD staff time associated with fang to comply by the above noted dates will b,, - <br />billed at the current hourly rate of $105 (beginning 8/1/09 the hourly rate will be <br />For this certification to be completethe 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, and/or photos <br />verifying corrections <br />• Operator's certification <br />Inspected By: <br />Facility Address: EPA IDU <br />I certify under penalty of law that: <br />1. 1 have corrected the violations specified in the Inspection Report from the above -mention <br />inspection date. i <br />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 Paperwork Statement <br />4. 1 am aware that there are significant penalties for submitting false information, including the <br />possibility of a fine and/or imprisonment for known violations. (HSC 25191) <br />I ON <br />9 <br />EHD 22-02-005 Rev 06/09 <br />am <br />I <br />