Laserfiche WebLink
12/14/2017 07:21 2094732344 MARCH LANE 76 PAGE 02/04 <br /> r4Y 1 r Environmental <br /> 1`. K +� { <br /> eRF <br /> .. rl I'I <br /> (�gd <br /> E D <br /> - `'i. I.�� l!6 <br /> C 14 27 <br /> RETURN TO COMPLIANCE CERTIFICATION ICSHEALTH <br /> Any MINOR violations noted in the"Notice to Comply"in the attached Inspection Report must be corrected within 30 days of 1T <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 o her A lat_. ions,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_ 3 unless otherwise specified in the <br /> Inspection Report. HSC 25185(e)(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 <br /> corrections <br /> Operator's certlfication <br /> Inspection Date: December 14, 2017 Inspected By: CESAR RUVALCABA <br /> Facility Address: 2701 W MARCH LN, STOCKTON CERS ID: 10181433 <br /> rce fy under penalty of law that: <br /> . 1 have corrected the violations specified in the Inspection Report from the above-mentioned inspection date,. 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—Z—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 possibility of a fine <br /> and/or imprisonment for known violations. (HSC 25191) <br /> Name: d' Q_t^ E 1,Q,r✓ Title: M G v\ ir— <br /> Signature: 7— j -7 <br /> Date: c <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.Sicehd.com <br /> Received Time Dec, 14. 2017 4: 03PM No. 2721 <br />