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Sep 23 15 07:29a Jiffylube 598• 92398763 p,3 <br /> San Joaquin County <br /> EnViroHealth <br /> n1868 East Hazelton A enue, SttocktonneCalifom at95205-6232 <br /> Telephone: (209) 468.3420 Fax:(209) 4663433 Web:www.sfQOv.OM/ehd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the-Notice to Comply,,in the attached Inspection Report must becorrected 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 within 30 days of receipt of the Inspection Report HSC 25404.1.2(c)(1) <br /> All corcections 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 dates 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 resuftsrmanifestsrtraining records/other appropriate paperwork, and/or photos verifying corrections <br /> Inspection Date: <br /> Inspected By: <br /> Facility Address <br /> I certify under penalty of law That: EPA ID: <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, and complete: <br /> —Photos <br /> 416_5�'—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 andr <br /> imprisonment for known violations. (HSC 25191) <br /> Name:— /VA <br /> Title: <br /> Signature: /iJ rjG— <br /> Date: <br /> i <br /> ii�r <br /> EGE1 VEL <br /> SEP 2 3 2015 <br /> ENVIRONMENTAL <br /> UCArV nCpgOT��C��r <br />