COMPLIANCE INFO_2019 - Laserfiche WebLink

Home Browse Search

SAN 10AQUIN RETURN TO COMPLIANCE CERTIFICATION Any MINOR violations noted in the " Notice to Comply" in the attached Inspection Report must be corrected within 30 days of receipt of this inspection. This certification form must be submitted to the Environmental Health Department ( EHD) address at the bottom of this form within 30 days of receipt of the Inspection Report, HSC 25404. 1 . 2(c) ( 1 ) All corrections to other violations noted in the attached Inspection Report ( IR) or Continuation Form , or disputes to any violations, are to be submitted using this certification and returned to EHD within 30 days unless otherwise specified in the Inspection Report, HSC 25185(c) (3) Note : All EHD staff time associated with failing to comply by the above noted dates will be billed at the current hourly rate. For this certification to be complete , the operator of the site must include: A statement documenting what corrective actions were taken or will be taken for each violation Copies of sample results/manifests/training records/other appropriate paperwork, and/or photos verifying corrections Operator' s certification Inspection Date: October 23 , 2019 Inspected By : JASON GAITAN Facility Address : 20107 N Ripon Rd , Ripon CERS On 10401217 certify under penalty of law that: 1 . I have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. 2 . 1 have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION and I believe the information to be true, accurate , and complete: Y Photos X _Paperwork y Statement 3 . 1 am authorized to submit this certification on behalf of the Respondent. 4 . 1 am aware that there are significant penalties for submitting false information , including the possibility of a fine and/or imprisonment for known violations . ( HSC 25191 ) Name : '6% 11 So' n4n f) i Title: 3u PO V Signature • S /�?� �z-✓ Date: 7 � �� Z