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02/10/2016 16:25 #0687 P.001/001 <br />��7 nn San Joaquin County HEGEIVED <br />q� <br />C �• \o - ., � f j Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, Califomia 95205-6232 FEB 10 2016 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgoy29/eh <br />ENVIRONMENTAL <br />RETURN TO COMPLIANCE CERTIFICATIOIW1="'TWnF7P4RTM1FNT <br />Any MINOR violations noted in the "Notice to Comply" in the attached Inspection Report must be m rected within 30 days of <br />receipt of this inspection. This certification form must be submitted to the Environmental Health Department (EHD) address; <br />the top of this form within 30 days of receipt of the Inspection Report, HSC 25404.12(c)(1) <br />All corrections to other violations noted in the attached Inspection Report (IR) or Continuation Form, or disputes to any <br />violations, are to be submitted using this certification and retumed 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/manifeststtraining records/other appropriate paperwork, and/or photos verifying corrections <br />Inspection Date: January 112016 Inspected By: STACY RIVERA <br />Facility Address: 13521 E MARIPOSA RD, STOCKTON EPA ID: <br />I certify under penalty of law that <br />1. I 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 />I believe the information to be true, accurate, and complete: <br />,Photos paperwork �Statement <br />3. 1 am authorized to submit this eertificaiion on behalf of the Respondent. <br />4_ I am aware that there are significant penalties for submitting false information, including the possibility of a fine and <br />imprisonment for known violations. (HSG 25191) <br />Name'Y I! to IYAiII EJ rrti�: N� <br />Signature: �A Date: 02, //D/ <br />iS U1+'1�S Y-) 1k <br />0_1, l" E,�� i` rvz) 1'k' is <br />4 At <br />.} ryvb Yle <br />R.� � �� c• h <br />tri/ C)oit, <br />IT <br />i S ate' v�e3 <br />c yob A-sA-P ,` 6 <br />J . 1 <br />4�" �y Mt"-') <br />