Laserfiche WebLink
SAN JOAQUIN <br />p,; _ ,r <br />f�vironmontal Health Department <br />RETURN TU COMPLIANCE CERTIFICATION <br />Any MINOR violations note( I In the "Notice to Comply" in the attached Inspecllon Repon must be corrected within 3p days of <br />receipt of this Inspection. This certifi(:allon form must be submitted to the Environmental Health f]epadment (FHD) address at <br />the bottom of this form within 30 days of roco!pt of the Inspection Report. HSC 25404.1.2(o)(1) <br />All corrections to other vtolallans noted In the attached Inspection Report (Ift) or Conllnualion 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 END staff time assoctaked 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 operalorof the site must include: <br />A statement documenting what corrective actions were taken or will be taken for each vinlalinn <br />Copies of sample resultslmanifesls/Training recordslother approprialo paperwork, andlorphotos verifying corrections <br />Operator's certification <br />Inspection Date: <br />certify under penalty <br />May 08, 2024 <br />Inspected 8y: <br />MATTHEW WON <br />Facility Address: <br />2440 OANIFI..S ST, MANTECA <br />CERS ID: <br />10146143 <br />of law that; <br />1. 1 have corrected the violations specified in the Inspection Report from the above-mentioned Inspection date. <br />2. I have persorlalry examined the following documentation submitted as proof of compliance FOR EACH VIOLA710N <br />and I hellava the ininrmalion to ha True, accurate, and complete: <br />X Photos X Paperwork <br />X Statement <br />3. 1 am authorized to submit Ihls certification on behalf of <br />the Respondent. <br />4. 1 am aware that there are significant penalties for submitting false Information, Including the possibility of a !ine and/or <br />Imprisonment for known vlolalions, (HSC 25191) d7 <br />Name: Chris Sigala Title:�(jr `�.S f ///�+41A• `� f <br />Signatufe-':- ....— �d fate: <br />