Laserfiche WebLink
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. slgov. org/ehd <br /> RETURN TO COMPLIANCE CERTIFICATION <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 Environmental Health Department ( EHD ) address ; <br /> the top of this form within 30 days of receipt of the Inspection Report. HSC 25404 . 1 . 2 (c ) ( 1 ) <br /> All corrections 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 30 days 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 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 , and/or photos verifying corrections <br /> Inspection Date : November 29 , 2018 Inspected By : STACY RIVERA <br /> Facility Address : 15 E GRANT LINE RD , TRACY CERS ID : 10181019 <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 <br /> believe the information to be true , accurate, and complete: <br /> Photos Paperwork X 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/ <br /> imprisonment for known violations . (HSC 25191 ) <br /> o � <br /> Name : ' �1K q , Title: �� ' ye � , <br /> r - <br /> Signature : Date : 0i <br />