Laserfiche WebLink
HWON AdSS : I 8102 Ol 'any awil pznizaad <br /> JOAQUIN Environmental H �� <br /> - <br /> COUNTY AUG 10 n <br /> r•."`=A.�: 2018 <br /> Greatness grows here, IIIV1I=0 <br /> RETURN TO COMPLIANCE CERTIFICATION PFR) ER N�1'M <br /> VICES <br /> Any MINOR violations noted in the"Notice to Comply"in the attached Inspection Report must be correc ed within 30 days of <br /> receipt 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 withln 30 days unless otherwise specified in the <br /> Inspection Report HSG 25165(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 vlolation <br /> Coples of sample results/manifests/training records/other appropriate paperwork, and/or photos verifying <br /> corrections <br /> Operator's certification <br /> Inspection Date: July 12, 2018 Inspected By: LYDIA BAKER <br /> Facility Address: 75 W VALPICO RD, TRACY CERS ID: 10182653 <br /> 1 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 VIOLATION <br /> and I believe the informatlon to be true, accurate, and complete* <br /> y4rS Photos ICS • Paperwork 7C%- 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) <br /> Name: - fit-► Title: 74a wL�Z . <br /> Signatur L* Date: 9- Z U 1 <br /> 1868 E. Hazelton Avenue( Stockton, California 95205( T 209 468-3420 1 F 209 464-0138 l www.sjcehd.com j■ <br /> ■ <br /> ■ <br /> ■ <br /> 100/100 'd 'ON xvd Wd �0 :ZO Idd/8I0Z/01/5I1; <br />