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nvironmental Health Department R <br />E <br />� El' <br />r I <br />1868 East Hazelton Avenue, Stockton, California 95205-8232 y <br />E D <br />Telephone: (209) 488-3420 Fax: (209) 468-3433 Web: yy Xtjgov.argJehd <br />MAY 2 6 2015 <br />RETURN TO COMPLIANCE CERTIFICATION <br />ENVIRONMENTAL <br />Any MINOR violations noted in the "Notice to CompV' in the attached Inspection Report must be _ ected wlthM5h1WFP1DTAACNIT <br />receipt of this inspection. This certification form must be submitted to the Environmental Health Department (EMD) address <br />the top of this form within 30 days of receipt of the Inspection Report. HSG 25404.1.2(c)(1) <br />AN p rrection� to other violations noted in the attached Inspection Report (IR) w Continuation Form, or disputes to any <br />violations, are to be submitted using this certification and returned to F -HD 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 resultstmanifestsltraining records/other appropriate paperwork, and/or photos verifying corrections <br />Inspection Date: April 15, 2015 Inspected By: FATINAH ZAREEF <br />Facility Address: 10858 TRINITY PKWY STOCKTON EPA ID: <br />certify under penalty of law that: <br />1. 1 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 VIOLATION <br />I believe the information to be true, accurate, and omplete: <br />Photos Paperwork Statement <br />3. ]am authorized to submit this certification on behalf or the Respondent <br />4. 1 am aware that there are significant penalties for submitting false information, including the possibility of a fine an <br />impHsonmegt for known violations. (1-130 25191) <br />Name: N I0 "— 0 l_ I_r:-'tA `N"-f� <br />