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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, California 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sigov.org/ehd <br />CONTINUATION FORM <br />Page: 6 of 6 <br />OFFICIAL INSPECTION REPORT <br />Date: 08/19/13 <br />Facility Address: 3633 Duck Creek Dr., Stockton <br />Program: HW <br />SUMMARY OF VIOLATIONS <br />CLASS I, CLASS II, or MINOR -Notice to Comply) <br />Note: (corrected on site) <br />The complete Return to Compliance paperwork for the January 9, 2012 inspection was not submitted. <br />The operator of the site or facility which receives an inspection report shall submit a written response to <br />the department or the local officer or agency within 60 days of receipt of the inspection report, or with a <br />shorter time as the department or local agency requires. This response shall include a statement <br />documenting the corrective actions that have been or will be taken by the operator. The missing <br />paperwork (training records) was submitted for review at the time of inspection. <br />Note: The CERS submittal was reviewed at the time of inspection. <br />Provided: Return to Compliance Certification form <br />ALL EHD STAFF TIME ASSOCIATED WITH FAILING TO COMPLY BY THE ABOVE NOTED DATES WILL BE BILLED AT THE CURRENT HOURLY RATE. <br />THIS FACILITY IS SUBJECT TO REINS ECTIO14 AT ANkTIME AT EHD'S CURRENT HOURLY RATE. <br />EHD Inspector: <br />Stacy Rivera (209) 468-3440 <br />Receiv By: <br />Title: <br />cl�C% <br />EHD 23-02-003 Rev 04/19/12 v \ CONTINUATION FORM <br />