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RECEIVgQJOAOUIN vI­)nr teritaI I—E!aI& Dep,artln,�nt <br /> EP 6 7 2013 <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES RETURN TO COMPLIANCE (::E:R,rlFI( ATl0N <br /> Any MINOR violations noted in the"Notice to Comply"in the attached Inspectior Report must ie corrected within 30 days of <br /> receipt of this inspection. This certification form must be submitted to the Envircim-ental Healt-i Department(EHD)address <br /> at the top of this form within 30 days of receipt of the Inspection Report. HSC 25404.1.>_(c)(1) <br /> All corrections to other violations noted in the attached Inspection Report(IR)or Continuation orm, or disp rtes to any <br /> violations,are to be submitted using this certification and returned to EHD within ZSQ days unless otherwise specified in the <br /> Inspection Repoot. HSC 25185(c)(3) <br /> Note: All END staff time associated with failing to comply by t1,c abc,ve nc,ted dates rill be <br /> billed at the current hourly rate. <br /> For this certification to be complete, the operator of the roust rcluce <br /> A statement documenting what corrective actiors were taken or will be Ten f D•east,violaton <br /> Copies of sample results/manifests/training reccrdslother appropriate pa parwc <,anclor photos verifying <br /> correctims <br /> Operator's certification <br /> Inspection Date: August 13, 2018 In-spected By: NICHOLAS LOEHRER <br /> Facility Add►ess: 2771 E FRENCH CAMP RD, MANTECA CERS ID: 10181191 <br /> I cert,ty under penalty of law that: <br /> 1 1 have corrected the violations specified in the Inspection Report from^ e above-mentioned inspec.on date. <br /> 2 1 have personally examined the following documentation submitted as pinof of complrance =0R E Ik:�H VIOLATION <br /> and I believe the information to be true, accurate,and complete: <br /> Photos ✓Paperwork ____ Stab:ment <br /> 3 1 am authorized to submit this certification on behalf of the Respondent <br /> 4 lam aware that there are significant penal,as fir submitting false info,,nation nclLo,ng the poss,t„Iity of a fine <br /> and/or imprisonment for known violations. (HSC:25191) <br /> Name:__ I"ItC��+✓` �a44rc Title:—.P. `1%+ M Acl -& -- <br /> Signature: Date: <br /> 12f•8 F HazeltonAverll.lej Stockton C alrf.irnta 95205 1 T 20194 1 A2C F ? 19 4r4-0138 I vNA%,slcehd corr <br />