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MAY-09-2017 12:47 From: To:4683433 Pa9e:2,2 <br /> REEDn <br /> San Joaquin County <br /> Environmental Health Department MAY 0 9 20'17 <br /> 1868 East Hazelton Avenus,Stockton,California 95205-6232 <br /> Telephone:(209)468.3420 f=ax:(209)458-3433 Web:www.siaov.orglehd <br /> ENVIRONMENTAL HEALTH <br /> RETURN TO COMPLIANCE CERTIFICATION DEPARTMENT <br /> Any MINOR violations noted in the"Notice to Comply"in the attached Inspection Report must be corrected within 30 days.of <br /> receipt of this inspection. This certification form must be submitted to the Environmental Health Department(EHD)address at <br /> the top or this form within 30 days of receipt of the Inspection Report. HSC 25404.1.2(c)(1) <br /> All corractions_to other violations noted in the attached Inspection Report(la)or Continuation Form,or disputes to any <br /> violations,are to be submitted using this certification and returned to EHD within 30_dunless otherwise specified in the <br /> Inspection Report_ HSC 25185(e)(3) <br /> Note: All EHD staff time associated with failing to comply by the above noted dates will be <br /> blued 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 verifying corrections <br /> Inspection Date: April 05, 2017 Inspected By: AARON HANG <br /> Facility Address: 800 W MOSSDALE AVE, LATHROP EPA Ib: <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 date. <br /> 2. 1 have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION <br /> and 1 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 that there are signifloant penalties for submitting false information.Including the possibility of a fine <br /> and/or imprisonment for known violations. (HSC 25191) <br /> 1_5'4q <br /> Name. le - Title: �fy <br /> Signatur Date: / <br /> �00 <br /> 301 AM S n J [r <br /> oil Ta-r/ts 7c�r'c <br /> or <br />