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COMPLIANCE INFO_2024
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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M
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1900 - Hazardous Materials Program
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PR0519837
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COMPLIANCE INFO_2024
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Entry Properties
Last modified
11/20/2024 4:38:44 PM
Creation date
10/15/2024 9:08:04 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1900 - Hazardous Materials Program
File Section
COMPLIANCE INFO
FileName_PostFix
2024
RECORD_ID
PR0519837
PE
1921 - HMBP-Regular-Primary Location
FACILITY_ID
FA0004483
FACILITY_NAME
RIPON CHRISTIAN SCHOOLS
STREET_NUMBER
435
Direction
N
STREET_NAME
MAPLE
STREET_TYPE
AVE
City
RIPON
Zip
95366
APN
25904010
CURRENT_STATUS
Active, billable
QC Status
Approved
Scanner
SJGOV\kblackwell
Supplemental fields
Site Address
435 N MAPLE AVE RIPON 95366
Tags
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 <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: <br />Facility Address: <br />Inspected By: <br />CERS ID: <br />October 08, 2024 <br />435 N MAPLE AVE, RIPON <br />PAUL NSO <br />10181633 <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 and/or <br />imprisonment for known violations. (HSC 25191) <br />Name:_____________________________________Title:________________________________ <br />Signature:__________________________________Date: _______________________________ <br />Eric A. Segaar Superintendent <br />November 7, 2024
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