Laserfiche WebLink
A N RJ 0A 0 U I N Environmental Health Department <br /> COUNTY <br /> p'. Grcotness grows here. <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(END)address at <br /> the bottom of this form within 30 days of receipt of the Inspection Report. HSC 25404.1.2(ck1) <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 END 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 billed <br /> at the current hourly rate. <br /> i <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 vlolatlon <br /> Copies of sample resuits/manifestsltralning records/other appropriate paperwork,and/or photos verifying comectlons <br /> Operator's certification <br /> I <br /> Inspection Date: September 09,2019 Inspected By: LYDIA BAKER <br /> Facility Address: 18362 E HWY 4, Stockton CERS ID: 10422813 <br /> I <br /> I certify under penalty of law that: <br /> 1. 1 have corrected the violations specified In the Inspection Report from the above-mentioned! <br /> I nspectien date. <br /> 2. 1 have personally examined the fallowing documentation submitted as proof cf compliance FOR EACH VIOLATION <br /> and I believe the inforrnallon to be true,accurate,and complete: <br /> I <br /> X Phoios _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 signlflcant penalties for submitting false Information,including the possibility of a fine <br /> and/or Imprisonment for known violations. (HSC 25191) <br /> Bruce Pinol <br /> Name: Title: Maintenance Tech <br /> Signature: Date: Za <br /> I <br /> i <br /> I <br /> I <br />