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San Joaquin County • <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, California 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sigov.ora/ehd <br />RETURN TO COMPLIANCE CERTIFICATION <br />Any IMINOviolations noted in the "Notice to Comply" in the attached Inspection Report must be corrected within 30 days of <br />receis inspection. This certification form must be submitted to the Environmental Health Department (EHD) address; <br />the tis 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,re to be submitted using this certification and returned to EHD within 30 days unless otherwise specified in the <br />Inspection eport. HSC 25185(c)(3) <br />Note: I All EHD staff time associated with failing to comply by the above noted dates will be <br />bil ed at the current hourly rate. <br />For thiS certification to be complete, the operator of the site must include: <br />A s atement 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 corrections <br />Inspection Date: July 20, 2016 Inspected By: VICKI MCCARTNEY <br />Facility ddress: 4219 E MORADA LN, STOCKTON EPA ID: <br />I certify uncler penalty of law that <br />1. 1 hove corrected the violations specified in the Inspection Report from the above-mentioned inspection date. <br />2. 1 hve personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION <br />I b lieve the information to be true, accurate, and complete: <br />Photos Paperwork Statement <br />3. 1 afn authorized to submit this certification on behalf of the Respondent. <br />4. 1 aln aware that there are significant penalties for submitting false information, including the possibility of a fine <br />imprisonment for known violations. (HSC 25191) <br />Ti <br />