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San Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, StoGRon,California 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.3l20v.ory(ehd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the"Notice to Comply'in the attached Inspection Report must be of <br /> receipt of this Inspection. This certification form must be submitted to the Environmental Health Department(EHD)address <br /> at the top of this form within 30 days of receipt of the Inspection Report HSC 25404.1.2(c)(1) <br /> All noted in the attached Inspection Report(IR)or Continuation Form,or disputes to any <br /> vioiatons, are to be submitted using this certification and returned to EHD within 30 days unless otherwise specified in the <br /> Inspection Report. HSC 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 results/manifests1training records other appropriate paperwork, and/or photos verifying <br /> corrections <br /> Inspection Date- Ferruary 1; ? ' ` Inspected By: Nilk"HELLE HENRY <br /> Facility Address: 3400 MAGARI HUR DR TRACY EPA ID•. <br /> I certiy under penalty of law that. <br /> 1. I have corrected the violations specified in the Inspection Report from tha above-mentioned inspection date. <br /> 2. 1 have personalty examined the folkhwing documentation submitted as proof of compliance FOR EACH VIOLATION <br /> and I 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. lam aware that there are significant penalties for submitting false information, including the poesibility,of a fine <br /> andlor imprisonment for known violations. (HSC 25191) <br /> Name:_ i A�^ 1 SI h r Title: Vf J� 7c l,' '3 �H f <br /> c <br /> Signatures` --- Date: <br /> 1 <br />