Laserfiche WebLink
SAN JDAUU 1',' l Env " ronmenio a 111=11m, rh Depauranvis <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 /> ivote , All EHD staff time associated with tailing to comply by the above noted dates will be <br /> billed at the current hourly rate. <br /> For this Certification t® 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 /> • Operator' s certification <br /> Inspection Date : January 10, 2019 Inspected By , ROBERT LOPEZ <br /> Facility Address , 4800 S AIRPORT WAY , STOCKTON CERS ID , 10181439 <br /> I 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 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 /> and/or imprisonment for known violations . ( HSC 25191 ) <br /> Name : Z' . 4 , <br /> a <br /> Signature : _ Date: . <br /> �•�'�v.-, � — � D � © n •� D � � it � � n �l m �i e E' C'v � r i' � fi ` a � <br /> � �� /Ye, rc1 � .3tC <br /> 7 " /-t U G� EX le) 6i YoG��rS /7(� �(�� 6'ee rep i1 � C� V��iiG` (.t (i T J L) <br /> ro6kPRECIPWE h <br /> jP S' 11 2019 <br /> LI <br /> 1" K1VIRQNML- id [AL HEAL,ffI <br /> — - PEnR' 'JT/SER ►J1rES <br />