Laserfiche WebLink
llllllpp�— 0 RECEIVED <br /> San Joaquin Count{ FEB 12 2018 <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton,CaVornia 95205-6232 EINVIRONNIENTAL HEALTH <br /> Telephone:(209)468-3420 Fax.(209)468-3433 Web:www.sigov.o0/ehd <br /> RETURN TO COMPLIANCE G"ERTIFICATION <br /> Any MINOR violations noted in the'Notice to Comply'in the attached Inspection Report must be corrected within 30 days of <br /> receipt of this inspection. This certification form must be submitted to the Envirtni-nent,-I Health Department(EHD)address <br /> at the top of this form within 30 days of receipt of the Inspection Report. HSC 25434.1 2(c)(1) <br /> All corrections to other violations noted in the attached Inspection Report(IR)of Continuation Form,or disputes to any <br /> violations,are to be submitted using this certification and returned to EHD withir.,�sQ dans 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 noted dates will be <br /> billed at the current hourly rate. <br /> For this certification to be complete, the operator of the sita must include. <br /> A statement documenting what corrective actions were taken or will be teiken for each violation <br /> Copies of sample results/manifestsilraining records/other appropriate I,aperwcrk,and/or photos verifying <br /> corrections <br /> Inspection Date: January 19, 2018 Inspected By: JOHN ALANIZ <br /> Facility Address: 2771 E FRENCH CAMP , MANTECA CERSID: 10181191 <br /> I certify under penalty of law that: <br /> 1. I have corrected the violations specified in the Inspection Report from tie 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 flaperworl,- V""Statement <br /> 3. 1 am authorized to submit this certification on behalf of the Responder-,. <br /> 4. 1 am aware that there are significant penalties for submitting false info:mation, including the possibility of a fine <br /> and/or imprisonment for known violations. (HSC 25191) <br /> 1 EAm -e <br /> Name:-- 1-itle:— 01 4r,IV4�,Z <br /> V <br /> Signature. —Date: <br />