Laserfiche WebLink
FEB-16-2016 01:51P FROM: TL:4683433 P.2/8 <br /> Ar <br /> San Joaquin County 11EUEN' "E6 <br /> Environmental Health Department <br /> 1868 East Hazefton Avenue,Stockton,California 98205-6232 <br /> Telephone:(209)468-3420 Fax:(209)488-3433 Web.rM.sjg2LeM&W FEB 16 2016 <br /> RETURN TO COMPLIANCE CERTIFICATION ENVIRONMENTAL <br /> HENTH rVFP4RTYFNT <br /> Any MIN013 violations noted In the"Notice to Comply"In the attached Inspection Report must be r&MggWd Vi thin 30 diva of <br /> receipt of this Inspection. This certification form must be submitted to the Environmental Health Department(EMD)address at <br /> the top of this form within 30 days of receipt of the Inspection Report. HSC 25404.1,2(c)(1) <br /> All g rLqctjg0j to other violations 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 jQdays unless otherwise specified in the <br /> Inspection Report. HSC 25185(c)(3) <br /> Note: All END staff time associated with falling 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 result4/mani(ests/training recordslother appropriate paperwork,and/or photos verifying corrections <br /> Inspection Date: February 16, 2016 Inspected By: CINDY VO <br /> Facility Address: 2320 N EL DORADO ST, STOCKTON 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 and <br /> I believe the information to be true,accurate,and complete: <br /> Photos Paperwork Statement <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4. 1 am aware that there are significant penalties for submitting false Information,Including the possibility of a fine and/or <br /> imprisonment for known violations. (HSC 26191) <br /> (:�') <br /> Z1Ze ;De <br /> Name: Title: <br /> Signature: Date:— <br /> C> I <br /> 41 Ce <br /> Lactk de-Ac,4ul r > 6 <br /> 41t <br />