Laserfiche WebLink
04/03/2015 12:47 5104758830 PAGE 05/06 <br />0 0 <br />San Joaquin County RECEIVED <br />Environmental Health Department <br />1868 Fast Hazellon Avenue, Stockton, Califbmia 95206-6232 <br />r~orw (209) 4e&3420 Fwc: (209) 468-3433 Web: w—wwW9oY.o-rgLqW APR 0 3 2015 <br />RETURN TO COMPLIANCE CERTIFICATION ENVIRONMENTAL <br />HFA!Twn;:DAQTAAIZMT <br />Any MINOR violadons noted in the Notice to CompW k attached Inspection Report must be comacted MmirjD gm of <br />receipt of this inspection. This certification form must be submitted to the Environmental Health Department (EHID) address <br />at the top of this form within 30 days of receipt of the Inspection ReporL HSC 25404.1.2(c)(1) <br />All corrections to ottm violations rmted in the aftcheo Inspection Report (IR) or Continuation Form, or disputes to any <br />violations, are to be submitted using thris caMeation and returned to EHD within 3Q dams unless otharwise specified in the <br />Inspection Report HSC 25185(c)(3) <br />Note. All EHD staff time associated wtth falling to comply by the above noted date* will be <br />billed at the current hourly rate. <br />For this certification to beCOMPlete, the operator of the site must include: <br />Astater nentdocumenting what corrective actions were taken orwill betaken for each violation <br />Copies of sample resuft/manilbstaftaining recordslother appropriate paperwork, and/or photos verhyng <br />corrections <br />Inspection Date: February 26, 2015 Inspected By., ELENA MANZO <br />Facility Address: 1001 E YOSEMITE AVE, MANTECA EPA Ilk <br />I oMMY under penalty of law #= <br />comcied the violations specftd in the Inspechori Report from the above-mentioned inspection date. <br />2. 1 have personally examktad the following documentation submitted as proof of compliance FOR 1EACH VIOLATION: <br />and I believe the Information to be true, accurate, and complete, <br />_PhoWs _Papaxwork _StstemeM <br />3. 1 am authortzed to submit this cerliffir-ation on behalf of the Respondent. <br />4. 1 am awwa flud there are signcant penalties for submitting %Ise infion-nati: on, including the possibilty of a fine <br />and/or imprisonment for known vk*Aons. (HW25191) <br />Name: <br />A <br />S <br />ignature: Date: <br />---- --------- <br />