Laserfiche WebLink
Environmental Health Department. <br /> 1868 East Hazelton Avenue,Stockton, California 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.siaov.orglehd <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 /> 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 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 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/manifests/training records/other appropriate paperwork, and/or photos verifying <br /> corrections <br /> Inspection Date: January 19. 2018 Inspected By: ELIANNA FLORIDO <br /> Facility Address: 816 E FRONTAGE RD. RIPON GERS ID: 10181513 <br /> 1 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 personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION <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 /> andlor imprisonment for known violations. (HSC 25191) <br /> Name: Title: 5 ecv <br /> 0,� <br /> Signature: Date: -- <br /> � r S T�+a� �cL �r.K.� 1 Li r✓/G !wt�-Tff L'�.-- <br /> ECEIVED <br /> 20 t 3`5 crop_ ire MAR 2 7 2018 <br /> ENVIRONMENTAL <br /> 7 DEPARTMENT <br /> ,`2- <9 e�X Py ��It, s'�7�,o -�� ';'� �i^,"-"�� �.��„� �.c u� '12� �C t l��'•v/t // <br />