Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,CA 95202-3029 <br /> Tele hone:(209)468-3420 Fax:(209)468-3433 Web:www.sj og v.or /g ehd <br /> RETLartment <br /> TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations he"Notice to Comply"in the attached Inspection Report must be <br /> corrected within 30 dayst of this inspection. This certification form must be submitted to the <br /> Environmental Health D (EHD) address at the top of this form within 35 days of receipt of the <br /> Inspection Report. <br /> All corrections to other vnoted in the attached Inspection Report(IR) or Continuation Form, or <br /> disputes to any violations, e submitted using this certification and returned to EHD within 30 days <br /> unless otherwise specified in the Inspection Report. <br /> Note: All EHD staff time associated with failing to comply by the above noted dates will be billed at <br /> the current hourly rate ( 122). <br /> For this Certlf cat on t0 be completethe operator of the site must include: <br /> • A statement docu enting what corrective actions were taken or will be taken for each violation <br /> • Copies of sample esults/manifests/training records/other appropriate paperwork,and/or photos <br /> verifying correcti s <br /> • Operator's certific tion <br /> Inspection Date: July 6, 2011 Inspected By: Garrett Backus <br /> Facility Address: 490 Claremont St EPA ID#: CAL000196538 <br /> I certify under penalty of law that: <br /> 1. 1 have corrected th violations specified in the Inspection Report from the above-mentioned <br /> inspection date. <br /> 2. 1 have personally examined the following documentation submitted as proof of compliance FOR <br /> EACH VIOLATIC N and I believe the information to be true, accurate, and complete: <br /> \ <br /> Photos X Paperwork I� Statement <br /> 3. I am authorized to ubmit this certification on behalf of the Respondent. <br /> 4. 1 am aware that the.,e are significant penalties for submitting false information, including the <br /> possibility of a fine and/or imprisonment for known violations. (HSC 2519 1) <br /> Name: ��WXAP4�itle:0, <br /> Signature: Date: — �— 11 <br /> EHD 22-02-005 Rev 08/10 <br />