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"ECA:I UEC; <br />San Joaquin County JUL 13 2015 <br />Environmental Health DepartmentF_NViRQN MENTq <br />1868 East Hazelton Avenue, Stockton, California95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: wwwsigov.om/ehd�4 Tc' �eog4rleenm <br />RETURN TO COMPLIANCE CERTIFICATION <br />Any AINOR violations noted in the"Notice to Comply" in the attached Inspection Report must be corrected within 30 da s of <br />race i t of this Inspection. This certification form must be submitted to the Environmental Health Department(EHD) addre, s <br />the t ip of this form within 30 days of receipt of the Inspection Report. HSC 25404.1.2(c)(1) <br />All c irrections to other violations noted in the attached Inspection Report (IR) or Continuation Form, or disputes to any j <br />viola Jons, are to be submitted using this certification and returned to EHDwithin 30 days unless otherwise specified in the <br />Insp lion Report. HSC 25185(c)(3) <br />Noe: All EHD staff time associated with failing to comply by the above noted dates will bei <br />billed at the current hourly rate. <br />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/manifesiMraining records(other appropriate paperwork, and/or photos verifying correcti' n; <br />i <br />ection Date: July 08 2015 Inspected By: NICHOLAS LOEHRER <br />lity Address: 192 Lathrop Rd Lathrop EPA ID: C/1 ooas 8l <br />I certify under penalty of law that: <br />I have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. <br />2. 1 have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATIO <br />I believe the information to be true, accurate, and complete: <br />Photos Paperwork Statement <br />3. I 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 andf <br />imprisonment for known violations. (HSC 25191) <br />Name: �esj l� I�wY ✓1 S Title: 7—/0 <br />7 �Cli11GZ I R /S <br />Rinnah ira• /iC_Y Date: /—�0 <br />