Laserfiche WebLink
Environmental Health Department <br /> SANJOAHIN <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MUM arFnbbom anted in the'N Mice to 1~ompie In UN atWcbEA lnspeckion Report must he C�Drrg�cwd ydth n N dw of <br /> receipl ref Jh s inspaAon. This certibrcation fora, must be submitked to the Environmenbaf Heaffh Dopar(rtient(EHO)address at <br /> floe bottom of this form wlthiri 30 days of receipt of kh6 ImipeW n Report. HSG 2$404-S,2{c)(l� . <br /> All co tl s k er Viv at' n n(Aed In the ar timl0jon Forttt,or&putes to any <br /> Ao%6Wi)s, are to be submilMd using this f FrcaCrvr+arra r read)o EHD vrltFjjn 3Q Maws unless other lse sbeciffed In the <br /> Inspecrtion Report HS 25186(c 3) — - <br /> Note: AN EHE?staff#fare assoclaled VAth failling to comply by tbo above no#ed dates vVill be biTied <br /> al tba arrant hourly rata. <br /> Far this certifi ation to be c0mpl te, ftaperstoror#wm,�must 1rdude-. <br /> A skatement documenting what coi-mGtive ac4km were taJm or MW be h*en for each v;olaklon <br /> Copies of sam frle resuftsolrn6mi&ests�PM9 racordsfoftr enpropriata pa rwork,arWor photos verifying wrrecklons <br /> QperafGft red t7cwm <br /> InspecNon Date: September 09, 2020 InspectL-d By; i fCr OLAS WEHRER <br /> Facility Address., 941 E D y F4, FrenO Camp CERS 10: /4145387 <br /> f�NJIY Under Ably of!aw that. <br /> V, l have conmrAed the violations spedhF d in khs Inspe0an Repcirf from[h'E�above-merw0aed inspertbn dnfe. <br /> 2. 1 have pwrsanafiy examines'ttre kMaMrQ dvrrr+rertafaon SLOV LEM as proof of com}plianey FOR EW H VIGtAWN <br /> and?tso%vu ftw k&3T matxa to bE trre, accmrat@r arW wrriplete; <br /> i <br /> Photos- _ P;�peWofk _ Werrnent <br /> 3, I am authorized to submit this aeWgQaifcarr on ba, ad&ete RaVonderrt, <br /> I <br /> 4- I am awu wa Mt fir A re skg hifica nit peri aWas for�ubrr+lkking false information,including the posObiffty of a from <br /> arO!Dr Irr prlsonmernk for known violation. (HSS 25 191) <br /> i Name: Titfe. <br /> 1 <br /> ignature; � Date. <br /> f <br />