Laserfiche WebLink
�09 � �� > o i ,aIeam.th Department <br /> SAN JOAQUIN � <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 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 corm , or disputes to any <br /> violations, are to be submitted using this certification and returned to EHD i hi 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 betaken 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: June 13 , 2019 Inspected By PAUL NSO <br /> Facility Address : 1721 S CHEROKEE LN , LODI CERS ID; 10180531 <br /> I certify under penalty of law that: <br /> 1 . I 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 /> Photos X paperwork "'L.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 tine <br /> and/or imprisonment for known violations ,_ (HSC 25191 ) . . . <br /> Name: Toni VonRuden Title: Environmental Manager <br /> Signature: Date: <br /> 1868 E . Hazelton Avonue I Stockton , California 95205 1 T 200 46834201 F 209 464-0138 I womsicehd. com <br />