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91LZ "N W Ol LIH ti� '�aQ au�il pania�a� <br /> ---T-�:: <br /> San Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Telephone: (209)468-3420 Fax:(209)468-3433 Web:www�jgov.M/ehd <br /> TURN TO COMPLIANCE C RTI 1 I <br /> Any UtN.QR violations noted in the"Notice to Comply" in the attached Inspection Report must be_ rrc oted wi in of <br /> receipt of this inspection. This certification form must be submitted to the Environmental Health Department(EHO)a dress <br /> at the top of this form within 30 days of receipt of the Inspection Report. HSC 25404.1.2(c)(1) <br /> All pprrections to g her violsItlons noted in the attached Inspection Report(IR) or Continuation Form, or disputes to an <br /> violations, are to be submitted using this certification and returned to EH within UAW unless otherwise specified i'i 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 b <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 results/manifests/training records/other appropriate paperwork, andlor photos verifying <br /> corrections <br /> Inspection Date: December 04, 2017 Inspected By: JOHN ALANIZ <br /> Facility Address: 1151W LOUISE AVE, MANTECA CERS ID: 10180661 <br /> I certify under penalty of law that: <br /> 1, I have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. <br /> 2, I have personally examined the following documentation submitted as proof of compliance FOR EACH VIOU n0N <br /> and I believe the information to be true, accurate, and complete: <br /> PhotosPaperwork Statement <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4. I am aware that there are significant penalties for submitting false information, including the possibility of a fin <br /> and/or imprisonment for known violations. (HSC 25191) <br /> Name: bALF1 Inq ZI-16 B I Title: <br /> Signature: � � � —Date: _ - ZZ— Z2 <br /> L000/Z000 121 NOHA21i3 13HUR dOZS ENO 6TL9CZ960Z XB3 Xd9T:ZT LTOZ/VT/ZT <br />