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COMPLIANCE INFO_2019
Environmental Health - Public
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PR0231487
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COMPLIANCE INFO_2019
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Last modified
9/3/2020 5:20:16 PM
Creation date
9/3/2020 5:08:44 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2019
RECORD_ID
PR0231487
PE
2351
FACILITY_ID
FA0000293
FACILITY_NAME
Pershing Holdings, Inc. DBA Esclon Arco
STREET_NUMBER
1329
STREET_NAME
ESCALON
STREET_TYPE
Ave
City
Escalon
Zip
95320
APN
22510003
CURRENT_STATUS
01
SITE_LOCATION
1329 Escalon Ave
P_LOCATION
06
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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SAN OQQ N I Environmental Health Department <br /> . <br /> u� r C0UNTY <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 dates of <br /> receipt of this inspection . This certification form must be submitted to the Environmental Health Department ( EHD ) address <br /> at the bottom 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 /> Operator's certification <br /> Inspection Date : February 19 , 2019 Inspected By : ZUNA BARKER <br /> Facility Address : 1329 Escalon Ave , Escalon CERS ID: 10746523 <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 /> and I believe the information to be true , accurate, and complete: <br /> X Photos XPaperwork 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 /> Name : Gurpreet Randhawa Title: CEO <br /> Signature : Date: 8 / 14/ 19 <br /> RPCEIV. E ` <br /> AUG 14 7019 <br /> ENVIRONMENTAL HEALTH <br /> 1868 E . Hazelton Avenue Stockton , California 95205 T 209 468 =3420 ( F 209 464 -0138 1 www. sjcehd. com <br />
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