Laserfiche WebLink
SAN JOAQpIN COUNTY <br /> ENVIRONMENTAL 4EALTH DEPARTMENT <br /> 600 East Mein Street,Stockton,CA 95202.3029 , <br /> Telethons;(209)468-3420 F"- (2Q9)"8-3433 Web:www.ejyov. ehtl <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the"Notice to Comply' in the attached Inspection Report must be <br /> corrected within 30 dam of receipt of this inspection. This certification form must be submitted to the <br /> Environmental Health Department(EHD)address at the top of this form within 35 days of receipt of the <br /> Inspection Report. <br /> All corrections to other violations noted in the attached Inspection Report(IR)or Continuation Form,or <br /> itisp��es to any vio ations, are to submitted ruing Obis cernfication and returned to EHD within 30 days <br /> unless otherwise specified in the Inspection Report. <br /> Note: All EHD sfaff time associated with falling comply by the above noted dates will be billed at <br /> the current hourly rate(5122), <br /> For this certlficatlon to be complet the operator of the site must include: <br /> • A statement documenting what corrective ac ions were taken or�vll be taken for each violation <br /> • Copies of sample results/manifests/training cords/other appropriate paperwork,and/or photos <br /> venfyng corrections <br /> • Operator's certification <br /> Inspection Date: November 5, 2010 Inspected By: Garrett Backus <br /> Facility Address: 1916 E March Lane EPA ID#:eA4Cco3q �SS� <br /> I certify under penalty of law that <br /> 1. I have corrected the violations specified in the inspection Report from the above-mentioned <br /> inspection date. <br /> 2. I have personally examined the following documentation submitted as proof of compliance FOR <br /> EACH VIOLATION and I believe the infomr ation to be true, accurate,and complete: <br /> Photos_kaperwork Statement <br /> 3. I am authorized to submit this certification on behalf of the Respondent. <br /> 4. I am aware that there are significant penalties for submitting false information, including the <br /> possibility of a fine and/or imprisonment for known violations.(HSC 2519 1) <br /> Name: NQS ��t Title: l�F� hTf Fn.2 <br /> Signature: c 4- 1` Date: //q— / 7 -- /12 <br /> EHD 22-02- ev 08/1 A _C i C) <br />