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San .Joaquin County <br />Etiu=rrr&tal Health Dapwirieni <br />1 NS East ltirzel; n Avenr.M, MaCkt0n, r ri MOS -6232 <br />Tefthonm (209) 4SS-U20 r*c: (:ri19) 493-3433 Web; www s�= org -hsf <br />RETURN TO COMPLIANCE CERTIFICATION <br />�3' 'h' lt~��7R vi�at;�r.# Hated hi 1� 'No11rs � �«^m�f' dy �e a?tr:+ed In&Ce�lan RCport t'Yu>.t tie Cnn�Ld w�l�:'Q� cf <br />r ipt ai t irrs�e'riQrr 1 res ,,ftaS►on tm mist be uibmitted to the Err or,tat I-fval n Iktpa;naa t (E.HD) adores <br />at the trP of tt:Is form w& -in SO days of tempt cf " l ,sp4mon Report. HSC 2541 12,?eg l ) <br />RA vN r�lvm to etner vu=s r.c= in the Wtane1 I" -pe --Jan Repact (IR) cr CuT&.ijaban F or disputes W eny <br />Vi0 i.0r:s, We W La V.&TICtrd usirrl ttS CCU'= bon and roomed !o EFID *12M 3D tays unless u#'er►nse bpiecfied f£t Itte <br />t:N.,,peci.= Report I= 251H(C)(3) <br />Note: All EHD staff fim associatud with [ailing to Comply by the above noted dates will be <br />billed at the current hourly rate. <br />For this certification to be complete, v* c4merAct of tr.a Irlty M=t a <br />A stalrment docLT.wnitag wi:ai =-.-actwa acgum vera taken ❑r wilt; tv tahen for each vtodzicsl <br />COpi.-i of sm--pie rwordrrother appmp -Ae pgpm,, k, andAx photos ve-,f inn <br />Crred;On9 <br />lnspoction Datm .1anuary 14, 21015 Inspectud By: ARIS VELIDSO <br />Facility Address: 22P,,i3S 5-KA—E-S 3111 Pr'. TPACY <br />i 'j un -jar peral;y cf isw CTat <br />EPA Ilk <br />1 I hwee =ne,'bed tta vickaOons W.-whied to the rnn;ectiDn R pc.t frCr.. 11"o as` YC1 mer�:i;vj lrnr, EzLcn day ?- <br />2 (ha:� pe�n�ly examired tl^n fottvws.-ag �merl�hx ��.:Gmtttf� $� pr�cf c! cw;.rt:anca F'DR Eh;vt I '�'1C�iATICfi <br />W -A 1 believe Cie tnfan-ra5cn to be tree, sc=attm ar d =-,Pleta. <br />,Pt s ",V,_P;prerwmr'kX _S1zWment <br />1 am sufhartz !a eubrnk this cer'%tirn on W21 of 0a Rosperdent <br />1 [an aware that are EvniTrr,.ant renaltep for 9W-,Atmg false Infrxrnat*n, lrc'.uQ-s�g to rc15t&j of a f m <br />and,'ar ImMscnrrent for kin violat om. (HSG x5191) t <br />c , a'. 1: T eQat y / <br />