Laserfiche WebLink
Pr3%25/2009 20:37 20933947 <br />LISA VERNENGO 0 <br />SAN JOAQUW COUNTY <br />1BNvIRoNMENTAL HEALTH DEPARTMENT <br />600 CA 95702-3029 <br />T (209) 3420 FA= M9) 46&3433 Weis: Mmm <br />PAGE 03 <br />Any MOR violations noted in the "Notice to Comply" in the attached inspection Report must be <br />ggrrectW within 30 days of receipt of this inspection.. This certifir4don form must be submitted to the <br />Environmental Health Department (EHD) address at the top of this form within 30 days of receipt of the <br />Inspection Report. <br />All qqmM(o= W.jQlWWn noted in the attached inspection .Report (IR) or Continuation Form, or <br />disputes to any violations, are to be submitted using this certification and returned to EHD within 3U days <br />unless otherwise specified in the Inspection Report. <br />Note: Ali EHD staff time associated with falling to comply by the shove noted elates W11 be billed at <br />the current hourly rate. <br />For this certification to beCOMplete the operator of the site must include: <br />• A statement docurawfing what corrective actions were taken or will be taken for each violation <br />• Copies of sample resultsfmanifests/training records/other appropriate paperwork, and/or photos <br />verifying corrections <br />Inspection Date: 19 6 Inspected By-/11-�, <br />Facility Address: &J 1D#: (�*/_ C6�� 'gel jo- <br />r e <br />Y 1 <br />1. I have corrected the violations specified in the Inspection Report from the above-mentioned <br />inspection date. <br />2. I have personally examined e0tos <br />in entation submitted as proof of compliance FOR <br />EACH VIOLATION and I information , a�ccu�ratcbompletc: <br />Paperwork Statement <br />3. .1 am authorized to submit this certification on behalf of the Respondent. <br />4. 1 ars, aware that there are significant penalties for submitting false information, including the <br />possibility of a fine and/or imprisonment for known violations. (HSC 25191) <br />0. <br />Title: <br />Date: <br />EHD 22-02-0015 Rev 08/08 <br />