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... SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. Hazelton Ave., Stockton, CA 95205 Telephone: (209) 468-3420 Fax: (209) 468-3433 Web:www.sicehd.com Complete and submit the "Return to Compliance Certification" form with the above corrections no later than 30 days from the date of the inspection. RECEIVED R SEEP 5 RETURN TO COMPLIANCE CERTIFICATIQL_ - PERMITJcc ^^ Any MINOR violations noted in the "Notice to Comply" in the attached Inspection Report must be corrected within 30 days of receipt of this inspection. This certification form must be submitted to the Environmental Health Department (EHD) address at the top of this form within 30 days of receipt of the Inspection Report. All corrections to other violations noted in the attached Inspection Report (IR) or Continuation Form, or disputes to any violations, are to be submitted using this certification and returned to EHD within 30 days unless otherwise specified in the Inspection Report. Note: All EHD staff time associated with failing to comply by the above noted dates will be billed at the current hourly rate of $125. For this certification t0 be complete the operator of the site must include: • A statement documenting what corrective actions were taken or will be taken for each violation • Copies of sample results/manifests/training records/other appropriate paperwork, and/or photos verifying corrections • Operator's certification Inspection Date: August 15, 2013 Inspected By:_Robert Lopez_ Facility Address:,20j6( i¢rd UI r�0os%/loQ EPA ID#: 10Y,5- 172 I certify under penalty of law that: 1. 1 have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. 2. 1 have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION and I believe the information to be true, accurate, and complete: Photos I.- Paperwork Statement 3. 1 am authorized to submit this certification on behalf of the Respondent. 4. 1 am aware that there are significant penalties for submitting false information, including the possibility of a fine and/or imprisonment for known violations. (HSC 25191) e Na iiu�l Title: RoG� �¢dc�c✓.