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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.sjgov.org/ehd EN.DF <br /> RETURN TO COMPLIANCE CERTIFICATION IT- <br /> Any <br /> MINOR violations noted in the"Notice to Comply' in the attached Inspection Report must be corrected within 30_days of <br /> receipt of;his inspection This certification form must be submitted to the Environmental Health Department (EHD)address, <br /> :he 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 /> vio ations, are to be submitted using this certification and returned to EHD within 30 days unless otherwise specified in the <br /> Inspecbcn Repot,. HSG 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 resultstmanifests/training records/other appropriate paperwork, anti/or photos verifying corrections <br /> Inspection Date: February 01, 2016 Inspected By: ELENA MANZO <br /> Facility Address: 1512 WEISS WAY, ESCALON EPA ID: CAL000401585 <br /> I certify under penalty of law that <br /> 1 1 have corrected the violations specified in the Inspection Report from the above-mentioned inspection dale <br /> 2 1 have personally examined the following documentation submitted as proof of compliance FOR FACH VIOLATION <br /> I believe the information to be true, accurate, and complete <br /> Photos Paperwork_ X--Statement See Attached <br /> 3 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4 1 am aware that there are sigrnhcant penalties for submitting false information, including the possibility of a fine and.' <br /> imprisonment for known violations. (HSC 25191) <br /> Name: Mike Eliason ___Title: Cardlock_ "Manager <br /> Signature-,��G �� —.Date: ___3/9/2016 -- <br />