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San Joaquin County EEIED <br /> Environmental Health Department <br /> 18138 East Hazelton Avenue, Stockton, Cal fomia 95205-6232 ��T 2 0 2014 <br /> 7elephorne.(209)468-3420 Farr(200)468-3433 Web:www rg/�ic�NMENTAL HEALTH <br /> RETURN TO COMPLIANCE CERTIFICATIO14EPARTMENT <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 /> at the top of this form within 30 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 EHD within 30 days unless otherwise specified in the <br /> Inspection Report. MSC 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 resultstrnanifestsltraining records/other appropriate paperwork, and/or photos verifying <br /> corrections <br /> Inspection Date: August '.8, 2014 Inspected By: JAMIE DE lA ROSA <br /> Facility Address: 4410 Waterloo Rd Highway 88 , Stockton 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 personalty examined the following documentation submitted as proof of compliance FOR EACH VIOLATION <br /> and I believe the information to be true, accurate, and complete: <br /> Photos„_Paperwork Statement <br /> 3. lam authorized to submit this certification on behalf of the Respondent. <br /> 4. lam 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: VIwo- HI. Title Ctiy�pcal i,. C`�L <br /> Signature: - Date: opt f i ?— (2otQ <br />