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COMPLIANCE INFO_2021
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1900 - Hazardous Materials Program
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PR0545942
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COMPLIANCE INFO_2021
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Last modified
1/4/2022 11:12:09 AM
Creation date
7/9/2021 10:01:28 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1900 - Hazardous Materials Program
File Section
COMPLIANCE INFO
FileName_PostFix
2021
RECORD_ID
PR0545942
PE
1920
FACILITY_ID
FA0025981
FACILITY_NAME
STANFORD CROSSING SDPS/WWPS
STREET_NUMBER
783
STREET_NAME
SPARTAN
STREET_TYPE
WAY
City
LATHROP
Zip
95330
APN
19203029
CURRENT_STATUS
01
SITE_LOCATION
783 SPARTAN WAY
P_LOCATION
07
QC Status
Approved
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SJGOV\kblackwell
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EHD - Public
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SANJOAQUIEnvironmental Health Department <br /> N <br /> ry ��&K� COUNTY <br /> {1FOia.. <br /> Greatness grows here, <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: June 23, 2021 Inspected By: NICHOLAS LOEHRER <br /> Facility Address: 783-785 SPARTAN WAY, LATHROP CERS ID: 10835488 <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 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 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: Title: <br /> Signature: Date: <br />
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