Laserfiche WebLink
SAN K A Q U I N Environmental Health Department <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 /> recelpt 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 Fonn, 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. HSC25185(c)(3) <br /> Note: All EHD staff time associated with falling to comply by the above noted dates will be <br /> billed at the current hourly rate. <br /> Forthis certification to be complete, the operator of the site must include: <br /> A statement documenting what conective actions were taken or will be taken for each violation <br /> Copies of sample results/manifestsltraming recordslother appropriate paperwork,andlor photos verifying corrections <br /> Opemi certifica8an <br /> Inspection Date: August 07, 2019 Inspected By: CESAR RUVALCABA <br /> Facility Address: 9010 HOWARD RD, STOCKTON CERS ID: 10185577 <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. I have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION and <br /> I believe the information to be true,accurate, and compllete: f <br /> Photos 1/ Paperwork ✓ Statement <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4. 1 am�t� <br /> ht thereora signifi t Marine for submitting false information,including the pose iGty of a fine andlor <br /> impmr known 6wla0o s (HSC 191) <br /> Name: �� 0 /✓� Title: <br /> Signature: Date: 2' <br /> 1868 E.Hazelton Avenue I Stockton,California 95205 1 T 209 4683420 1 F 209 484-0138 1 www.sjcehd.com <br />