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COMPLIANCE INFO_2020
EnvironmentalHealth
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2200 - Hazardous Waste Program
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PR0545404
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COMPLIANCE INFO_2020
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Last modified
11/9/2020 1:51:56 PM
Creation date
9/14/2020 12:33:39 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2200 - Hazardous Waste Program
File Section
COMPLIANCE INFO
FileName_PostFix
2020
RECORD_ID
PR0545404
PE
2220
FACILITY_ID
FA0025788
FACILITY_NAME
BLOSSOM FARMS HQ
STREET_NUMBER
11227
Direction
E
STREET_NAME
EIGHT MILE
STREET_TYPE
RD
City
STOCKTON
Zip
95212
CURRENT_STATUS
01
SITE_LOCATION
11227 E EIGHT MILE RD
P_LOCATION
01
QC Status
Approved
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SJGOV\dsedra
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EHD - Public
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1 =� Environmental Health Department <br /> i � i.,A k, al , <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: September 08, 2020 Inspected By: CLAUDIA MURO <br /> Facility Address: 11227 E EIGHT MILE RD, STOCKTON CERS ID: 10827100 <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. 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 S 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 and/or <br /> imprisonment for known violations. (HSC 25191) <br /> Name: a 144 ` Title: OWN e r— <br /> signature. I Date: /y —& " 2o ZO <br />
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