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r -c y,/z! <br />Z -& <br />SAN JOAQUIN Environmental Health Department <br />RETURN TO COMPLIANCE CERTIFICATION <br />thin 30 <br />Mations noted in the "Notice to Comply" in form must bethe attached submitted to /the Eniion viironRmennt I Health [ eport must be corrected epartment I(EHD) address days o <br />ispection. This certification <br />form within 30 days of receipt of the Inspection Report. HSC 25404.1.2(c)(1 <br />All corrections to other. violationsotehin is certif cationthe eand returnedd InspectionRto EHD within_30 days unnless t erwise speeport (IR) or Continuation Frm, or disputes cified edrin the <br />using <br />violations. are to be submitted 9 <br />Inspection Report. HSC 2151 85(c)(3) <br />ith failing to comply by the above noted dates will be <br />Note: All EHD staff time associated w <br />billed at the current hourly rate. <br />For this certification to be Complete, the operator of the site must include: <br />A statement docu,renting what corrective actions were taken or will be taken for each violation <br />Copies of sample results/manifests/training records/other appropriate paperwork, and/or photos verifying <br />corrections <br />Operator's certif cation <br />Inspected By: JAMIE LIMA <br />Inspection Date: June 16. 2016 <br />Facility Address: 5010 HOLMAN RD, STOCKTON <br />CERS !D: 10185203 <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 personalIV examined thefeollleaccurate, <br />owing do udocumentation <br />and ion submitted as proof of compliance FOR EACH VIOLATION <br />and I believe the information tobe <br />Photos _ X Paperwork Statement <br />3. 1 am authorized to submit this certification on behalf of the Respondent. <br />4. 1 am aware that there are significant penalties for submitting false information, including the possibility of a fine <br />and/or imprisonment for known violations. (HSC 25191) <br />Name:atx4f ; Y _ Title: O�rI FX <br />Signature Date: <br />