Laserfiche WebLink
Oct 01 08 11:11a Pro Lube <br />12095443637 p.1 <br />ybbbdl(j p.1 <br />09/79/2003 TUE L1: 20 FAX 20946-33 SJC Bae !41992/902 <br />EG <br />`i.t <br />SAM JOAQUIM COUNTY EGA %-� <br />aENYIROHMENTA,LFIEALTH.DFPARTMENT <br />�srocxton, CA 95202.3029. _ VC. T' 012(}08 <br />: ielaphoiu 1209) 468-3420 Far: (20 91 469-3 413 We$ wwwsiaov.orv/did <br />- :.::-•8ANJ0AQUINC0 NTY. <br />;'•.. 7! ,ENTAL <br />.....---: ... ....,.:,•:: 'HFAC <br />tAI)ERMTWN'k <br />-IM111 ZtN_TO-COMP LIANCE'CERTIFICAnON.•.:.` :....:.., <br />Any - N3 IINORviolations noted in the. 'Wotiee.to-Cornply" in the attached Inspection Reporl.must be <br />corrected within 30 days of receipt of this inspection. This certification form mustho sit <br />lmtitted to the <br />Environmental Health Department (EHD) itddress 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 fiornl, or <br />disputes to any violations, are to be submitted using this certification and returned to EHD within 30 darn, <br />-unless otherwise specified in the Inspection Report...: <br />Not¢: All EHD staff time asspcb#*d with failing to comply by the above noted dates will be billed at <br />.the current hourly rate <br />For this certlflc3tIon to be COMPIete the operator oftbesile must include: <br />•...A statement docurneatingwhat corrective actions weretaken or will be taken for each violation <br />�... Copies of sample results/mamfestsJtraiaing reeords/other apprgpriatepaperwork, anWOr photos . <br />verifying corrections <br />9. ' .Opamtoi s certification <br />Irispect-Pon Date: Inspected By: <br />Facility Address: S N� 5 . CheLe-%r- A - EPA IDN: C.t rL obo a-9 3 ? <br />1 certify tinder penalty of law that: <br />I have corrected the violations specified in the lnspection Report from the above-mentioned <br />inspection date <br />2. [have personally examined the following documentation submitted as proof of eompfiance'MR. <br />EACH VIOLATION and 1 believe the infomation to be true, accurate, and complete: . <br />Photos �e Paperwork 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 tine and/or imprisonment for kuown violations. (HSC 25191), <br />Signature:' <br />EHD 22-02-005 Rev I I IG7 <br />Title: V P <br />Date: <br />