Laserfiche WebLink
San Joaquin County <br />Environmental Health Department <br />1888 East Hazelton Avenue, Stockton, California 95205-6232 <br />Telephone: (209) 488-3420 Fax: (209) 488-3433 Web: www.sicov.ora/ehd <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 />recelpt 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(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 the <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 <br />corrections <br />Inspection Date: Jul/ 11, 2018 Inspected By: <br />JOHN ALANIZ <br />Facility Address: 2610 LYCOMING ST, STOCKTON CERS ID: 10184063 <br />I certify under penalty of law that: <br />1. 1 have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. <br />2. 1 have personally examined the following documentation submitted as proof of compliance FOR EACH VIOIATION <br />and I believe the information to be true, accurate, and complete: <br />Photos Paperwork 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 imprisonment for known violations. (HSC 25191) 1 L <br />Name: ir•S --:7L Tiile: 41 dno / 0dyb-i4ny ILL� <br />Signature: Date: / <br />