Laserfiche WebLink
• 01/12/2015 13:53 1561 CHEVRON PA <br /> jGE, , 6/06 <br /> San Joaquin County <br /> JAN 12 2015 Environmental Health Department FEB 12 2015 <br /> 1868 East Hazelton Avenue,St ektan,California 85205-6232 <br /> Telephone:(209)468-3420 Fax:(209),468-3433 Web.,www.sigy�v�land ' N: VIR ONMENTX <br /> RETURN TO COMPLIANCE CERTIFICATION J <br /> Any MINOR violations noted in the"Notice to Comply"in the attached Inspection Report must be cow withE 3� o dw of <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 26444.1.2(c)(1) <br /> Ali corrections 10 Other violations noted In the attached Inspection Report(IR)or Continuation Form,or disputes W any <br /> violations,are to be submitted using this certification and returned to EHD within 3 days unless otherwise specified in the <br /> Inspection Report HSC 25185(c)(3) <br /> Note:All EHD staff time associated with failing to comply by the above rioted 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 rec:ordslother appropriate paperwork,and/or photos verifying <br /> corrections <br /> Inspection Date: January 12, 2015 _ T Inspected By: ELENA MANZO <br /> Facility Address: 1103 S MAIN ST, MANTECA EPA ID: <br /> I certify under penalty of law that <br /> 1. 1 have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. <br /> 2. 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 <br /> Paperwork Statement <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent <br /> 4. t am aware that there are significant penalties for submitting false tnforrntation,including the possibility of a fine <br /> and/or im n,ent for known violations. (HSC 26191) <br /> Name: Titic:U:S <br /> Signature: J Crate: <br />