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COMPLIANCE INFO_2021
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1900 - Hazardous Materials Program
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PR0528002
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COMPLIANCE INFO_2021
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Entry Properties
Last modified
9/24/2021 12:05:37 PM
Creation date
9/15/2021 8:21:38 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1900 - Hazardous Materials Program
File Section
COMPLIANCE INFO
FileName_PostFix
2021
RECORD_ID
PR0528002
PE
1920
FACILITY_ID
FA0018972
FACILITY_NAME
JOES SMOG SHACK INC.
STREET_NUMBER
500
Direction
E
STREET_NAME
TENTH
STREET_TYPE
ST
City
TRACY
Zip
95376
APN
23519015
CURRENT_STATUS
01
SITE_LOCATION
500 E TENTH ST UNIT E
P_DISTRICT
005
QC Status
Approved
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SJGOV\kblackwell
Tags
EHD - Public
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SAN JOAQUIN <br />`jr•F <br />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 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 resultslmanifestsltraining records/other appropriate paperwork, and/or photos verifying corrections <br />Operator's certification <br />Inspection Date: September 14, 2021 Inspected By <br />Facility Address: 500 E TENTH ST UNIT E, TRACY <br />I certify under penalty of law that: <br />CAROL PRESTO <br />CERS ID: 10187017 <br />1. I 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 <br />and/or imprisonment for known violations. (HSC 25191) <br />Name: ONA �(i W Title: V ` <br />Signature: <br />Date: G �� -2 �U <br />
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