Laserfiche WebLink
SAN J O A Q U I N Environmental Health Department <br />lL OUNTY� <br />910iYS iter€. <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 at <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 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 betaken for <br />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: September 22, 2020 Inspected By: <br />Facility Address: 21001 N ELLIOTT RD, LOCKEFORD <br />I cert <br />ify under penalty of law that: <br />CLAUDIA MURO <br />CERS ID: 10183627 <br />1. I have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. <br />2. I have personally examined the following documentation submitted <br />as proof of co�Ppliance FOR EACH VIOLATION <br />and I believe the information to be true, accurate, and complet . / <br />Photos Paperwork IV Statement <br />3. I am authorized to submit this cert <br />ification on behalf of the Respondent. <br />4. I am aware that there are significant penalties for submitt <br />ing false information, including the possibility of a fine and/or <br />imprisonment for known violati�ons�fi. (HSC 25191) <br />Name: P&r-k"V 5u�//yr keay,ti( Title: IM vta .g2f: <br />Signature:�t f �• ty — �� Date: �� l Sl Z Q <br />