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San Joaquin County �,y- <br /> Environmental Health Department NOV 12 Uig <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.smov.org ov.or / hd ENR A( <br /> ERMITISEIT/gERvl,. , <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the"Notice to Comply"in the attached Inspection Report must be correc ed withu 30 days of <br /> receipt of this inspection. This certification form must be submitted to the Environmental Health Departent(EH )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 c isputes I any <br /> violations,are to be submitted using this certification and returned to EHD within 30 days unless otherw se speci ed in the <br /> Inspection Report. HSC 25185(c)(3) <br /> Note: All EHD staff time associated with failing to comply by the above noted dat swill e <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 be taken for each violation <br /> Copies of sample results/manifests/training recordslother appropriate paperwork,and/or photo verifyin <br /> corrections <br /> Inspection Date: October 31, 2017 Inspected By: H VA S EED <br /> Facility Address: 251 D ARCY PKWY, LATHROP CERS ID: 10184 17 <br /> 1 certify under penalty of law that: <br /> 1. I have corrected the violations specified in the Inspection Report from the above-mentioned ins ection te. <br /> 2. 1 have personally examined the following documentation submitted as proof of compliance FO R EACH IOLATION <br /> and I believe the information to be true,accurate, and complete: <br /> Photos Paperwork Statement <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent.1 <br /> 4. 1 am aware that there are significant penalties for submitting false information, including the po sibility c a fine <br /> and/or imprisonment for known violations. (HSC 25191) <br /> Name: ( rew t �of5iAe, Title: AlAilk Gr o� <br /> Signature:z i _ Date: /17 <br />