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RECEIVED <br /> San Joaquin County MAY 31 2018 <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 ENVIRONMENTAL <br /> Telephone: (209) 468-3420 Fax: (209) 468-3433 Web:www.sjgovQU@WDEPARTMENT <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 day <br /> eceipt of this inspection. This certification form must be submitted to the Environmental Health Department (EHD) addr <br /> he top of this form within 30 days of receipt of the Inspection Report. HSC 25404.1.2(c)(1) <br /> 411 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 tl• <br /> Inspection Report, HSC 25185(c)(3) <br /> Note: All EHD staff time associated with failing to comply by the above noted dates will b <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/training records/other appropriate paperwork, and/or photos verifying correcti <br /> Inspection Date: February 16 2016 Inspected By: STACY RIVERA <br /> Facility Address: 4469 S ESCALON BELLOTA BLVD, FARMIN EPA ID: <br /> I certify=the <br /> f law that: <br /> 1. the violations specified in the Inspection Report from the above-mentioned inspection date. <br /> 2. lly examined the following documentation submitted as proof of compliance FOR EACH VIOLATI( <br /> ormation to be true, accurate, and 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 of a fine a <br /> imprisonment for known violations. (HSC 25191) <br /> Name: O Q C' J G f - Title: Yi� <br /> Signature: <br /> Date: <br /> h+ " <br /> %k 5 <br /> :' sS. <br />