Laserfiche WebLink
San Joaquin County RECEIVED <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Telephone:(209)468-3420 Fax: (209)468-3433 Web:www.sigov.org/ehd MAR 16 2015 <br /> RETURN TO COMPLIANCE CERTIFICATIOIENVIRONMENTAL <br /> N7A7y^7PAPTIA7N%7 <br /> Any MINOR violations noted in the"Notice to Comply"in the attached Inspection Report must be corrected within 30 dayj of <br /> receipt of this inspection. This certification form must be submitted to the Environmental Health Department(EHD)address <br /> the top of this forth 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 day.4 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 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 results/manifeststtraining records/other appropriate paperwork, and/or photos verifying corrections <br /> Inspection Date: March 04. 2015 Inspected By: FATINAH ZAREEF <br /> Facility Address: 4445 N PERSHING AVE, STOCKTON EPA ID: 646p©2_8297Z33 <br /> I certify under penalty of law that: <br /> 1. I have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. <br /> 2. 1 have personalty examined the following documentation submitted as proof of compliance FOR EACH VIOLATION <br /> 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 and/ <br /> imprisonment for known violations. (HSC 25191) <br /> Name: "4 Title: (5�GdCOtF'� <br /> Signature: 11A Date: <br /> `T/fes c/Sf 9 4�L TiPn7K G,JiCL <br /> ole i -jc. 4soon ,gS lva f T>' � i �4c,5�FD �.✓.0 <br /> ef N9�� )ca �� <br /> <br /> <br />