Laserfiche WebLink
San Joaquin County <br />Environmental Health Department. <br />1868 East.Hazelton Avenue, Stockton, California 95205-6232 <br />Telephone: (209)468-3420 Fax: (209) 4W3433 Web: www.sigov.org/ehd <br />K UURN TU G4MPLIANCE *p M 11rICATIUN <br />Any MINOR violations noted in the "Notice to Comply" in the attached Inspection Report must be correc ed witin 30 da's of <br />receipt of this inspection. This certification form must be submitted to the Environmental Health Depariment'(EHD) address <br />at.the top 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 retumed.fo 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 />. <br />A statement documenting what corrective actions were taken or will be taken for each vviolation. <br />Copies of sample results/manlfests/tralning records/other appropriate_paperwork, and/or photos verifying: <br />corrections <br />Operator's certification <br />Inspection Date: June 03, 21719 <br />1. _. Inspected By: <br />Facility Address: 1399 E YOSEMITE AVE CERS ID: <br />I certify under penalty of law that: <br />Paul Nso <br />1a180675 <br />1. 1 have corrected the violations specified in the Inspection Reportfrom the above-mentioned inspection date. <br />2. 1 have personally examined the following documentation submitted as proof of compliance FOREACH VIOLATION <br />and I believe the information to be true, accurate, and complete: <br />Photos • Paperwork wk, tement <br />3. 1 am authorized to submit this certification on behalf of the wRespondenf. <br />4. I am aware.that there are significant penalties. for submitting+ false information, including the possibility of a fine <br />and/or imprisonment for known violations. (HSC 25191) <br />Name: UC � ©�(��� Title:. ��^ch� i\ <br />Signature: ____ Date: <br />