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COMPLIANCE INFO_2019
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PR0539457
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COMPLIANCE INFO_2019
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Last modified
8/3/2020 11:31:05 AM
Creation date
8/3/2020 11:28:02 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2200 - Hazardous Waste Program
File Section
COMPLIANCE INFO
FileName_PostFix
2019
RECORD_ID
PR0539457
PE
2248
FACILITY_ID
FA0014405
FACILITY_NAME
UNIVERSITY OF THE PACIFIC PHYSICAL
STREET_NUMBER
1050
Direction
W
STREET_NAME
BROOKSIDE
STREET_TYPE
RD
City
STOCKTON
Zip
95211
APN
11026004
CURRENT_STATUS
01
SITE_LOCATION
1050 W BROOKSIDE RD
QC Status
Approved
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SJGOV\dsedra
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EHD - Public
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SAN JOAï¿œUIN <br />C 0 U N T Y <br />L r'lekT Greotness grows here. <br />Environmental Health Department <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 at <br />the bottom 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 corrections <br />Operator's certification <br />Inspection Date: August 08, 2019 Inspected By. TRICIA DAI <br />Facility Address: 1050 W BROOKSIDE RD, STOCKTON <br />I certify under penalty of !aw that: <br />CERS ID: 10184635 <br />1. I have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. <br />2. I 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. I am authorized to submit this certification on behalf of the Respondent. <br />4. I am aware that there are significant penalties for submitt <br />ing false information, including the possibility of a fine <br />and/or imprisonment for known violations. (HSC 25191) <br />Name <br />Signal <br />
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