Laserfiche WebLink
Environmental Health Department <br /> SAN-JOAQUIN i <br /> ! --'"�=Wt- COUNTY-- <br /> `.~�r:p•:r' Grcotncss grows hcrc. <br /> s RETURN TO COMPLIANCE CERTIFICATION / <br /> Any MINOR violations noted in the"Notice to Comply"In the attached Inspection Report must be corrected within 30 days 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 25404.1.2(c)(1) <br /> All corrections to other violations 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 EHD within 30 days unless otherwise specified in the <br /> Inspection Report. HSC 25185(c)(3) <br /> Note: All EHD staff time associated with failing to comply by the above noted dates will be <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/manifests/training records/other appropriate paperwork,and/or photos verifying <br /> corrections <br /> Operators certification <br /> Inspection Date: April 03, 2019 Inspected By: LYDIA BAKER <br /> Facility Address: 711 W GRANT LINE RD,TRACY CERS ID: 10183567 <br /> 1 certify under penalty of law that: <br /> 1. 1 have corrected the violations specified in the Inspection Report from the above-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. 1 am aware that <br /> there <br /> fsignificant <br /> a( HSC 2518lfitting false information,including the possibility of a fine <br /> and/or impnsonmeor known violations.pen <br /> ���(�,�� Title: t'�W v\CT <br /> Name: <br /> Date: <br /> Signature: <br /> 1868 E Hazelton Avenue I Stockton, <br /> California 95205 T 209 468-3420 i F 209 464-0138 www.sjcehd.com <br /> Scanned by CarnScanner <br />