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COMPLIANCE INFO_2023
EnvironmentalHealth
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CAROLYN WESTON
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1900 - Hazardous Materials Program
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PR0547922
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COMPLIANCE INFO_2023
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Last modified
10/24/2023 9:50:37 AM
Creation date
10/24/2023 9:48:55 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1900 - Hazardous Materials Program
File Section
COMPLIANCE INFO
FileName_PostFix
2023
RECORD_ID
PR0547922
PE
1921
FACILITY_ID
FA0026131
FACILITY_NAME
7-ELEVEN INC. #38616
STREET_NUMBER
601
Direction
W
STREET_NAME
CAROLYN WESTON
STREET_TYPE
BLVD
City
STOCKTON
Zip
95206
APN
16422019
CURRENT_STATUS
01
SITE_LOCATION
601 W CAROLYN WESTON BLVD
P_LOCATION
01
QC Status
Approved
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SJGOV\kblackwell
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EHD - Public
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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 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 />· Copies of sample results/manifests/training records/other appropriate paperwork, and/or photos verifying corrections <br />· Operator’s certification <br />Inspection Date: <br />Facility Address: <br />Inspected By: <br />CERS ID: <br />September 19, 2023 <br />601 W CAROLYN WESTON BLVD, STOCKTO <br />KRISTINA SAETERN <br />10898722 <br />I 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. I 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. I am authorized to submit this certification on behalf of the Respondent. <br />4. I 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:_____________________________________Title:________________________________ <br />Signature:__________________________________Date: _______________________________ <br />Janet Wager Regional Gasoline Environmental Compliance Manager <br />X <br />10/16/2023
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