Laserfiche WebLink
2092928113 PAGE. 1/ 2 <br />- t 0!5-f 2_ 4f ?� <br />15-fZ4f9� <br />RECEIVED <br />San ,toaquln County <br />EMIT <br />onmental Health Department <br />1988 East Hazelton Avenue, Stockton, Callfornia952058232 <br />iolephone: (209) 468-3420 Fax: (209) 468-3433 Web: YfllCds)Q9Y..9S9��r% <br />2 2018 <br />ENVIRONMENTAL <br />HEAISw nFcARTAeFNT <br />RETURN TO COMPLIANCE CERTIFICATION <br />�of <br />violations Hoed In the "Notice to Compq' in the attached Inspection Report must be o <br />AnyN11I�4R ort. HSC25404A,2(c)(1) <br />receipt of this inspection, lwot d in deyls oftrecelpt of lhetlnspecbml Rep the Environmental Health Department (EHD) ad Less <br />ny <br />at the top of this form <br />unless otherwise specified in the <br />All goz!`119 Ik1� noted in the attached Inspection Report (IR) or Continuation Form, or dlsputea o a <br />violations. <br />non re to beInsFulornitted <br />HSC 25185(r)(3) above <br />certlflcatlon end returned to END <br />Note: All EHD staff time assoelated with falling 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 />Copies of sample renting what <br />corrective a tion, records <br />appropriate paperwork, and/or photos verifying <br />A statement documenting what corrective actions were taken or will be taken for each violation <br />corrections Inspected By: ROBERT LOPEZ <br />Inspection Date: Janna 08.2D18 HERS ID: D <br />Facility Address: 1679 S UNION ST STOCKTON <br />I tartunder Penalty of law that; <br />above-mentioned Inspection date <br />1, I have corrected the violations specified In the Inspection Report trom the roof of compliance FOR EACH VIOLATION <br />2 end I believe the inforrmato the bfeltrue, Gcdu°a a®andlaompletatted as p <br />Photos <br />�., Paperwork�statement <br />3. 1 am authorized to submit this certification on behalf of the Respondent. possibility of a fine <br />a. I om aware that there are significant penalties for submitting false information, Including the p <br />and/or imprisonment Tor Know^.,s,eri^^ l�si251114 )p <br />n 1i�6 QISh1Dv1 0 {l l , c <br />Name: <br />��� <br />/�([ oate: <br />