Laserfiche WebLink
OSIb'CN WdbO S 8101 '8l'd;S aw11 panlaaaa <br />SA p I (Environmental Health Department <br />-- '`'JUNj I' ..... RECEIVED <br />.. t•: art�. st; :�.: •. rrs.`: 0. SEP 1 J 2U�U <br />RETURN TO COMPLIANCE CERTIFICATION <br />ENVIRONMENTAL HEALTH <br />HRMITISERMCES <br />Any MINOR violations noted In the "Notice to Comply" in the attached Inspection Report must be correct -2 within 3 evs of <br />receipt of this inspection. This certification form must be submitted to the Environmental Health Department (EHD) address <br />at the top of this form within 30 days of receipt of the Inspection Report. HSC 25404.1.2(e)(1) <br />All corrections to other violations nohad 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 speelfled in the <br />Inspection Report. HSC 25185(c)(3) <br />Note: All EHPJ 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 resultshranlfestanrair.ing recordsluther'rp, ropnate pspervrork, and/or photos verifying <br />corrections <br />Operator's certification <br />Inspection nate: August 21, 2018 _ Inspected By: <br />JAMIE LIMA <br />Facility Address: 1612 W HAMMER LN, STOCKTON CERS ICI: 10181241 <br />I certify under penalty of law that: <br />1, 1 have corrected the violadcris spedfled in the Inspection Report from the ebovz-mendoned inspection date. <br />2. 1 have personally examined the fallowing documentation submitted as proof Cf ccmpliancE FOR EACH VIOLATION <br />and I believe the information to be true, accurate, and complete: <br />Photos paperwork_ L 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 impnsonmont for known violations. (HSC 26191) <br />Name: J E' Title:_ DW/t e <br />Signature:.��-----------._-- <br />Ati- C�6r� �l sc5 `✓► Ce /,S <br />-7 <br />�r 6 v pk-v 6Q-(.5 <br />1868 E. Hazelton Avenue l Stockton. California 95205 1 T 209 468-3420 l F 209 464-0138 1 www.sjcehd.com <br />:■ <br />s■ <br />