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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />186&East Hazelton Avenue, Stockton, Califomia 95205-6232 <br />irt n-rize * 1=1 # ME <br />v Mpvt VIM Turn-ITTRAin 311 oays oT rec- <br />Inspection Report. HSC 25404.1.2(c)(1) <br />All gorrectigns to other violations noted in the attached Inspection Report (IR) or Continuation Form, or <br />disputes to any violations, are to be submitted using this certification and retumed to EHD within 30 days <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 doMplete 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/manifeststtraining records/other appropriate paperwork, and/or photos <br />verifying corrections <br />• Operator's certification <br />Inspection Date: August 6, 2014 Inspected By -E. Manzo <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 Statement <br />F 1111! T i 1 11 p �1�11 11 � III 1111�11 <br />IMMMEM= <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 />71170M <br />EHD 22-02-005 Rev 04/19112 <br />WAneI 1-4&KfQ --------- '' I I I . 1-1--l-l-l""''", "I',- I 1 11 11-111, <br />