Laserfiche WebLink
SQN_JUQ UI N Environmental Hea'I#Iti'D'��yrtr'ltr�nt <br /> p <br /> COUNTY AUG 2 3 2013 <br /> "V�tt, erw Greatness yrcm; i, <br /> l:i\VIIZUNMl:iV'1'AL IIEAI;I'll <br /> RETURN TO COMPLIANCE CERTIFICATION DEPARTNIENT <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 at <br /> the bottom 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 dans 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 corrections <br /> Operator's certification <br /> Inspection Date: August 01, 2019 Inspected By: NICHOLAS LOEHRER <br /> Facility Address: 8055 S ASH ST, FRENCH CAMP CERS ID: 10182565 <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 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: �t�'' Stvh,b>N�c,14- Title: �(k��" OpE7ZA-nbm ' Int <br /> Signature: Date: <br /> I/ jr <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />