Laserfiche WebLink
SAN JOAOUIN <br />Environmental Healln Ueparlmr-nit <br />Mr -s -I > r%jh! ri+ IPA FP^r t+v_-m�1�11'w►r 1 IVB! <br />�c- i u�iiij i i�C.iltnr iLi�nv>L vL-PL <br />r" <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. I his certitication form must be submitted to the environmental Health Uepartment (EHU) address s' <br />the bottom of this form :nthin 30 days of rcceipt of the Inspection Roport. HSC 25404.1.2(c" <br />:Ail 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 />Irl.>UCI:IIVI l TCUUI I. IlJlr 2J 1 W,I.nJ) <br />iwte; rin 2"M Stan dole a-ssOclaled It;1 iaiiiag 'to by Vila above iwted dates iitiIII be ,lled <br />At the C.Vrrr�rA hmir ty rn2P• <br />For this Cee LI I tcattio 1 to be Co 1 kpi'e e, the operator of the site must include: <br />A stntP.ment dmtmentina what cxwre-Give acSi..;,c were. takan or wit, be. take ; for e-Rrh viotatits ; <br />::opies of sample results/manifests/training records/other appropriate paperwork, and/or photos verifying corrections <br />Operator's certification <br />Inspection Date: 2z2-7- Inspected By: 6AS (SLA <br />p(G1 <br />A2CTA - <br />C,q c7s2� <br />taatniay_ Address: �- S7tu�i CE --,S Iv: L <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 bolieve'I le information to be true, accurate, and complete: <br />Ftwfos PapefW0A o�" sFatrrrent <br />3. 1 am authorized to submit this certificetion on behalf of the Respondent. <br />/1 1 �..� a..�rP t7.ot tl.uru ro c.nn:{:n�nt ne��tt:ac fr�r c..tK..itlin' (�tco i.�fnrm�linn in,q.vtinn /lw'v�c e:t':t:t.I n(� firm <br />and/or imprisonment for <br />/known violations. (HSC 25191) J <br />Name: `�t-ttJ }�l�vC�K�2 Title: l� G l L� <br />Signature:_ - - Date: Io/�7-6 ��'ZZ <br />