Laserfiche WebLink
SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, California 95205-6232 <br />ullfA�:13112 <br />11'-11 "'IWII§Wlliliil�ilw <br />Environmental Health Department (LAL)) aaaress at Me 10p OT InIS TOrM witnin-441 Gays Of fecelpt 01 LF <br />Inspection Report. HSC 25404.1.2(c)(1) I <br />F-21WME�]IInt no I I . I <br />*115PFtt-,U to die VALA11—zi" e-yWj7Z".#j,7Fy <br />unless otherwise specified in the Inspection Report. HSC 25185(c)(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 completethe 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 <br />verifying corrections <br />• Operator's certification <br />Inspection Date: November 20, 2012 — Inspected ByAris Cacapit <br />Facility Address: 1111 S Stockton St Lodi CA EPA ID#: CAL000045081 <br />1. 1 have corrected the violations specified in the Inspection Report from the above-mentioned <br />inspection date. <br />2. 1 have personally examined the following documentation submitted as proof of compliance FOR <br />EACH VIOLATION and I believe the information to be true, accurate, and complete: <br />Photos _Paperwork 7N Statement <br />4. 1 am 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 />Name: Title: <br />Signature:IDate* [1P — macezow.- J z; <br />EHO 22-02-006 Rev 04/19112 DEC 17`2012 <br />I k <br />,. is . 0 1 C <br />WWI III,, -1W <br />M 7.11 -A 1 6 1 F <br />