Laserfiche WebLink
F � � � Environmental Health Department <br /> r as <br /> 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 bottom of this form within 34 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 corrections <br /> Operator's certifications <br /> Inspection Date: July 16, 2019 Inspected By: JOHN ALANIZ <br /> Facility Address: 704 ZEPHYR ST, STOCKTON CERS IID: 10184853 <br /> 1 certify under penalty of law that: <br /> 1. I 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 Respondeat. <br /> 4. 1 am aware that there are significant penalties for submitting false information, inHi,riinrg the possibility of a fine and/or <br /> imprisonment for known violations. (HSC 25191) <br /> Name: Ron lexande Title: General Manager <br /> Signature:__tf te. 07/30/2019 <br /> 1888E Hazelton AvenUi�, j Stockton. t 21" fcrnia 95205 T 20_9 488-3429 � F 209464-0138 1 "",i.s;cehd.com <br />