Laserfiche WebLink
SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT RECEIVED <br />1868 E. Hazelton Ave., Stockton, CA 95205-6232 <br />Telephone. (209) 468-3420 Fax. (209) 468-3433 Web: www.sipov.org/ehd <br />MAY 2 3 2013 <br />ENVIRONMENTAL HEALTH <br />RETURN TO COMPLIANCE CERTIFICATIONIERIIIT/SERvrCE.S <br />Any MINOR violations noted in the "Notice to Comply" in the attached Inspection Report must be <br />corrected within 30 days of receipt of this inspection. This certification form must be submitted to the <br />Environmental Health Department (EHD) address at the top of this form within 35 days of receipt of the <br />Inspection Report. <br />All corrections to other violations noted in the attached Inspection Report or Continuation Form, or <br />disputes to any violations, are to be submitted using this certification and returned to EHD within 30 days <br />unless otherwise specified in the Inspection Report. <br />Note: All EHD staff time associated with failing to comply by the above noted dates will be billed at <br />the current hourly rate ($125). <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 <br />verifying corrections <br />• Operator's certification <br />Inspection Date: April 24, 2013 Inspected By: Garrett Backus <br />Facility Address: 10858 Trinity Parkway EPA ID#: CAR000201806 <br />I certify under penalty of law that: <br />1. I have corrected the violations specified in the Inspection Report from the above-mentioned <br />inspection date. <br />2. I have personally examined the following documentation submitted as proof of compliance FOR <br />EACH VIOLATION and I believe the information to be true, accurate, and complete: <br />Photos _X–Paperwork —X—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 <br />possibility of a fine and/or imprisonment for known violations. (HSC 25191) <br />Name: Pauline Calalang Title: UST Coordinator <br />Signature: Date: &1.210 //3 I <br />EHD 22-02-005 Rev 10-07 <br />