Laserfiche WebLink
IrL- <br /> San Jeaquin County RECF <br /> Environmental Health Department <br /> 1668 East Hazelton Avenue, Stockton , California 952056232rtr�r QP -u - 1 n n 2 , Zola <br /> Telephone. (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov. org/ehd l <br /> RETURN TO COMPLIANCE CERTIFICAT ONMENTAL HEALTH <br /> DEPARTMENT <br /> Any MINOR violations noted in the " Notice to Comply" in the attached Inspection Report must be s da of <br /> receipt of this inspeGtion . 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(0) (7 ) <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 EHL) within 30 days unless otherwise specified in the <br /> Inspection Report . HSC 25186 (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 /> Inspection Date: December 19, 2018 Inspected By : STAGY RIVERA <br /> Facility Address : 2701 W MARCH LN , STOCKTON CERS ID: 10181433 <br /> I 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 LStatement <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 information , including the possibility of a fine <br /> and/or imprisonment for known violations. (HSC 25191 ) <br /> Name . Title. V*�q ;' ✓F" <br /> Signature: Date. <br /> A4 <br />