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COMPLIANCE INFO_2022
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2300 - Underground Storage Tank Program
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PR0231667
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COMPLIANCE INFO_2022
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Last modified
11/8/2022 10:41:35 AM
Creation date
4/18/2022 7:57:45 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2022
RECORD_ID
PR0231667
PE
2361
FACILITY_ID
FA0002121
FACILITY_NAME
JAMAR SERVICE
STREET_NUMBER
4075
Direction
E
STREET_NAME
MAIN
STREET_TYPE
ST
City
STOCKTON
Zip
95215
APN
15726411
CURRENT_STATUS
01
SITE_LOCATION
4075 E MAIN ST
P_LOCATION
99
P_DISTRICT
002
QC Status
Approved
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SJGOV\kblackwell
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EHD - Public
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pur>rc Hea- h C)}GGiI)�lU�l� tll��lll <br /> ..�.NY f , ° SANAOAOF�1!1 <br /> i COUNTY- <br /> �ce,Fo+���� Greotness 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: May 10, 2022 Inspected By: STACY RIVERA <br /> Facility Address: 4075 E MAIN ST. STOCKTON CERS ID: 10180873 <br /> 1 certify under penalty of law that: <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 Oe 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 /> imprisonmentforknown violations. (HSC 25191) <br /> Name: Title: <br /> Signature: Date: 5 <br />
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