Laserfiche WebLink
San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, California 95205-6232 <br />7elephone: (209) 46$x3420 l=ax; (209) 468-3433 V1/eb; www.sjcrov.orgiehd <br />RETURN TU UUMPLIANOrtm ULRTII✓ICATIUIN <br />Any MINOR violations noted in the "Notice to Comply" in the attached inspection Report must be porrected withir�30 days cif <br />receipt of this inspection. This cartification form must be submitted to the Environmental Health Department (EHD) address <br />at the top of this farm within 30 days of receipt of the Inspection Report. HSC 25404.1.2(c)(1) <br />All corrgctions to othervW. tia ons 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 EHib within 30 days unless otherwise specified in the <br />Inspection Report. HSC 25185(c)(3) <br />Note: All AHC? stft kime asot�d with failing tQ cl�npl�r by ter alboveJnQCd dates <br />. _ wl,llill b__..__..._._ k_.._. <br />_ .... ..._ _ lEilfe`dt the current Yi+urly rate. <br />. <br />FOl" fihi certificafiiorl 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 resuitshnanifosts/training records/other appropriate paperwork, and/or photos verifying <br />corrections <br />Operator's certification <br />Inspection Date: August 20, 2020 Inspected By. Paul Nso <br />Facility Address: 1229 E LOUISE AVE CERS ILS: 10186837 <br />I certify under penalty of law <br />that: <br />1, I have corrected the violations specified in the Inspection Report frorin the above-mentioned inspection date. <br />2. E have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATIC3iV <br />and I believe the information to be #rue, accurate, and complete: <br />Photos Paperwork Statement <br />3. 1 am authorized to submit this certification on behalf of the Respondent. <br />I am aware that there are significant penalties for submitting false information,, including <br />N <br />the possibility of a fine <br />and/or imprisonment fQr known viola#ions. {HSC 2519'1) f., <br />Signi3tu re: Date <br />APR 2 7 2021 <br />