Laserfiche WebLink
SAN 10 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 Inspectlon Report(IR)or Continuation Fomi,or disputes to any <br /> violations,are to be submitted using this certification and returned to EHD within 3Q days unless otherwise specified in the <br /> Inspection Report. HSC 251a5(cX3) <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 /> Copes of sample results/manifestshreining records/other appropriate paperwork,and/or photos verifying corrections <br /> Operator's certification <br /> Inspection Date: October 26, 2020 Inspected By: JOHN ALANIZ <br /> Facility Address: 3032 S EL DORADO ST, STOCKTON CERS ID: 10181297 <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 personalty 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 /> 1 3 4 <br /> Photos Paperwork Statement <br /> 3. 1 am authorized to submit this certification on behalf of the Responden(. <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:-jP-,Cy-h l C\0.-VoQ Title: <br /> Sig re: _ Date: V yck I2C)2 7N <br />