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COMPLIANCE INFO_2020
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1900 - Hazardous Materials Program
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PR0539726
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COMPLIANCE INFO_2020
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Entry Properties
Last modified
11/20/2024 9:08:18 AM
Creation date
9/8/2020 11:11:53 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1900 - Hazardous Materials Program
File Section
COMPLIANCE INFO
FileName_PostFix
2020
RECORD_ID
PR0539726
PE
1921
FACILITY_ID
FA0022728
FACILITY_NAME
Verizon Wireless Victoria Island Farms
STREET_NUMBER
16021
Direction
W
STREET_NAME
STATE ROUTE 4
City
STOCKTON
Zip
95206
APN
129-190-29
CURRENT_STATUS
01
SITE_LOCATION
16021 W HWY 4
QC Status
Approved
Scanner
SJGOV\dsedra
Tags
EHD - Public
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SAN , J O A Q U I N 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 billed <br /> 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 26, 2020 Inspected By : ROBERT LOPEZ <br /> Facility Address : 16021 W HWY 4 , STOCKTON CERS ID : 10600393 <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 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 : Am" Dow& Title . <br /> Signature : Date : � /3 �/7-0 <br />
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