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FEES-19-2016 11:29 IHTEF'STATE OIL P.01 L <br /> _---0�,� p�(,p San Joaquin County <br /> Environmental Health Department %V D <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Telephone:(209)468-3420 Aax:(209)468-3433 Web:w^...sjgov-org/ehd <br /> FEB 19 2016 <br /> RETURN TO COMPLIANCE CERTIFICATIONEWRONMENTAL <br /> 1-11=4ITU nCD9PTAiiChrr <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 <br /> at the top of this form within 30 days of receipt of the Inspection Report. HSC 25404.1.2(c)(1) <br /> All porrections to other violafigns noted in the attached Inspection Report(IR)or Continuation Form, or disputes to any <br /> violations, 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/manifests/training records/other appropriate paperwork, and/or photos verifying <br /> corrections <br /> Inspection Date: Januwy 20, 2016 Inspected By: STACY RIVERA <br /> Facility Address: 4900 E Mariposa Rd, Stockton EPA ID: <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 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. 1 am aware that there are significant penalties for submitting false information, including the possibility of a fine <br /> and/or imprisonment for known violations, (HSC 25191) <br /> Name: -/' <br /> title: <br /> Signature: Date: c <br /> a <br /> �y <br />