Laserfiche WebLink
San Joaquin Cvunly <br /> Environmental Heaifh Deparlmw t <br /> 1868 East Hazedon Avenue.ShK*k n,Cafifomia gs2w-8232 <br /> ral@pharasr(209)468-3420 ter:(2aa)4sg-3433 Warr: <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR Holations noled in the`Notice to Comply In the aftached Inspeclion Report must be gaagg ed within 30 days of <br /> reoeipt of this inspection. This certification form must be submitted to the Environmental Heab Department(EHD)address <br /> at the top of this form within 30 days of recelpt althe In spedfon Report HSC 23404.1.2(c)(1) <br /> All moons to other vk* tone noted in the attadled Inspedian Report QR)or Continuation Form,or disputes to any <br /> ii[Gr�uorss.arc w uc tiiiUiiriliw=u>siiy iiue vmffl i—1 wid re-unimu w=nu ii-MILL-i B wino UII uuiufvnw iiw i�m <br /> Inspection Report. HSC 251B(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 cei#ification to be complete, the gmmmr of the site must include: <br /> A statement documenting what corrective actions were faker or will be taken 1br each violation <br /> Copies of sample resullWmani ants framing reoordsiftwfher appropriate paperwa .anWor phi verifying <br /> corrections <br /> Inspection Date: March 14, 2017 Inspected By: ROBERT LOPEZ <br /> Facility Address: 1W W MAIN ST, STOCKTON CERS ID: 10182891 <br /> I certify under penalty of taw that: <br /> 1. 1 have connected fire vlolatlons spied in the Inspection Report bw the abmmmrmytioned inspection date. <br /> 2. I have personal examined the fb owfng documentation ad milled as proof of compliance FOR EACH VIOLATION <br /> and I belleve the information to be true,accurafe,and compieW <br /> Photos X Paperwork Statement <br /> 3. 1 am audwrized to submit this ceriificellon on behalf of the Respondent. <br /> 4. 1 am more that thane are signir=ft penalties for submitting false lrrformadon,including the possibifty of a Me <br /> andfor Imprisonment for known violations. (HSG 251 S1) <br /> Name: �I vtzhIL'E WLW Titles -4 <br /> r <br /> Signature: - Data: 'I G — <br />