COMPLIANCE INFO_PRE 2019 - Laserfiche WebLink

Home Browse Search

SAN JOA UIN COUNTY r ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street,Stockton,CA 95202-3029 Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sieov.org/ehd JUN 2 9 ^008 HEALTH PER5T/ScRVICES RETURNTO COMPLIANCE CERTIFICATION Any MINOR violations noted in the"Notice to Comply" in the attached inspection report must be corrected within 30 days of eceipt of this inspection. This certification form must be submitted to the Environmental Health Dep ment(EHD) address at the top of this form within 35 days of receipt of the inspection report. All corrections to other violations noted in the attached Inspection Report (IR) or Continuation Form, or disputes to any violations, are to be submitted using this certification and returned to EHD within 60 days unless otherwise specified ir the IR. For this certification to be complete the operator of the site must include: • A statement docum ating what corrective actions were taken or will be taken for each violation • Copies of sample re ults/manifests/training records/other appropriate paperwork, and/or photos verifying correction • Operator's certification t Inspection Date: �° 3 Inspected By: Facility Address: i d 00 J . t IZ, S _ A UEPA ID#: 041 00th '736)"'1 �)� ,t- I certify under penalty o law that: 1. I have corrected the iolations specified in the Inspection Report from the above-mentioned inspection date. 2. 1 have personally exmined the following documentation submitted as proof of compliance FOR EACH VIOLATION and I believe the information to be true, accurate, and complete: _Photos v1" Paperwork /" Statement 3. I am authorized to s mit this certification on behalf of the Respondent. 4. I am aware that there are significant penalties for submitting false information, including the possibility of a fineand/or imprisonment for known violations. (HSC 25191) Name: itle: 0 ilk Al &, y \ Signature: ��7/7Date: C 6 EHD 22-02-005 Rev 05/07