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',2/13/2010 17:26 Tuff Boy Sales Inc, Lathrop (FAX)209 858 2835 P. 004/005 <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax. (209) 468-3433 Web: y88w-sJgov.org/egN <br />RETURN TO COMPLIANCE CERTIFICATION <br />Any MINOR violations noted in the "Notice to Comply" in the attached Inspection Report must be <br />corrected within 30 days of receipt of this Inspection. This certification form must be submitted to the <br />Environmental Health Department (EHD) address at the top of this form within 30 days of receipt of the <br />Inspection Report. <br />All corrections to other violations noted in the attached Inspection Report (IR) or Continuation Form, or <br />disputes to any violations, are to be submitted using this certification and returned to EHD within 30 days <br />unless otherwise specified in the Inspection Report. <br />Note: All EMD 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- results/manifests/training records/other appropriate paperwork, and/or photos <br />verifying corrections <br />• Operator's certification <br />Inspection Date: 11/8/10 Inspected By: Thuy Tran <br />Facility Address: 3870 w. Yosemite Ave %gft hrg?A 10#: CAT.0on0432114 <br />I certify under penalty of law that: <br />1. 1 have corrected -the violations specified in the Inspection Report from the above-mentioned <br />inspection date, <br />2. 1 have personally, examined the following documentation submitted as proof of compliance FOR <br />EACH VIOLATION andel believe the Information 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'th'atthereare significant penalties for submitting false information, including the <br />posslbillty of afire and/or imprisonment for known violations. (HSC 25191) <br />Name: <br />Tltle:_o.fety Monaca. <br />Signature: `j , Date: (2, (! ? &0 <br />Request',f extension of time to comply is attached. <br />Additional letter requesting extension of time mailed 12/10/10. <br />EHO 22.02.006 Rev 10109 <br />