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-- - San Joaquin County <br /> Environmental Health Department SEP p 8 7.015 <br /> 1868 East Hazelton Avenue, Stockton, Californiag5205-6232 <br /> Telephone:(209)468-3420 Par:(209)468-3433 We&www_siaov.org/eh�NVIRONMENTAL <br /> I,_-. I Tl1 ryC'(]A OTS/CRIT <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the"Notice to Comply"in the attached Inspection Report must be corrected within 30 days of <br /> receipt of this inspection. This certification form must be submitted to the Environmental Health Department(EHD) address <br /> the top of this form wlthln30 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 disputes to any <br /> violations, are to be submitted using this certification and returned to EHDwithin 30 days unless otherwise specified In the <br /> Inspection Report. HSC 25185(c)(3) <br /> Note: All EHD staff time associated with failing to comply by the above noted date$ will be <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/raining reoords/other appropriate paperwork, and/or photos verifying correction: <br /> Inspection Date: August 10, 201E Inspected By: NICHOLAS LOEHRF=R <br /> Facility Address: 246 W I_.OIJISE AVL:, MANTECA EPA ID: <br /> I certify under penalty of law that: <br /> 1. 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,arycf complete: <br /> Photos 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?f a fine and/ <br /> imprisonment for known violations\ (MSC 25191) <br /> Name: _Title: 0L1 J-t-r <br /> Signature: Date: qA11 <br /> 9 /b HSVd tV 60: b0 STOZ '90 'dag <br />