Laserfiche WebLink
San Joaquin County <br /> 1868 East Hazelton Avenue Health Department parornia <br /> (209) 468 -3420 Fax: <br /> California 95205 -6232 <br /> �' (209) 468-3433 Web; www. s . ov. or /ehd <br /> RETURN TO COMPL ►gNCE <br /> Any MIS violations noted in the "Notice CERTIFICATION <br /> receipt of this inspection . This certifiation for mo <br /> at the top of this form within 30 days of receipt of hey in the attached Inspection Report <br /> must be sub P rt must be corrected within 30 da sof <br /> submitted to the Environmental Health Department (EHD <br /> Inspection Report. HSC 25404 . 1 . <br /> All corrections to other violations noted in the attached Inspection violations , are to be submitted using 2 (c) ( 1 ) ) address <br /> Inspection Report. HSC 25185 c g this certification and returned to within 30 da Continuation Form <br /> ( ) (3) or disputes to any <br /> unless otherwise specified in the <br /> Note : All EHD staff time <br /> billed at the current hour) raassociate,With failing to Comply Y ate. pI Y by the above noted dates Will be <br /> For this certification to be com <br /> A statement documentin plete ) the o <br /> perator of the site <br /> g what corrective actions were taken or will be taken for each v ' <br /> ifests/training records/other a must include : <br /> Copies of sample results/man <br /> corrections <br /> ppropriate paperwork <br /> Operator's certification solation <br /> and/or photos verifying <br /> Inspection Date : December 19 , 2017 <br /> Facility Address : 8660 LO Inspected By : Elianna Florido <br /> LOWER SACRAMENTO RD <br /> I certify under penalty of law that: CER $ ID : 10181351 <br /> 1 . 1 have corrected the violations specified in the Inspection <br /> 2 I have personally examined the followingReport from the above-mentioned inspection date . <br /> and I believe the information to be true, accurate,ddocumentation submitted as proof of compliance FOR and complete: REACH VIOLATION <br /> 3 . I am authorized to Photos Paperwork Statement <br /> 4 . I am aware that t ' ,(� of the Respondent. <br /> and/or imprisonrrj� - formation , including the possibility of a fine <br /> Name : ne <br /> Signature: 11111111111111111 11011 P <br /> te: <br />