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� � RECEIVE04' <br />San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, California 95205-6232 ENVIRONMENTAL.: <br />Telephone: (209) 468-3420 rax: (209) 468-3433 Web: s ov:or /ehd UFA07P nFOAtaT�Ct 1T <br />RETURN N TO COMPLIANCE CERTIFICATION <br />" otice to Comply" in the attached Inspection Report must be corrected within 3 days of <br />Any MINOR violations Hated in the N p �' p p <br />receipt of this inspection. This certification form must be submitted to the Environmental Health Department (EHD) address; f <br />the top of this form vrithin 30 days of receipt of the Inspection Deport. HSC 26404.1.2(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 returned to EHD within 30 dam unless otherwise specified In the <br />Inspection Report. HSC 25185(c)(3) <br />Note: All EHD staffs time associated with failing to comply by the above noted dates will be <br />billed at the current hourly gate. <br />For this certification to be complete, the operator of the site mustinclude: <br />A statement documenting what correcilve actions were taken or will be taken for each violation <br />Copies of sample results/manifests/trainIng recordslother appropriate paperwork, and/or photos verifying corrections <br />Inspection Date: June 26 2015 Inspected By: FATINAH ZAREEF <br />Facility Address: 3100 NAD ART RD, STOCKTON Epp, ID: CAL000276412 <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 Mate. <br />2. 1 have personally examined the following documentation submitted as proof of compliance FOR EACH V1oLA-fION <br />I believe the Information to be true, accurate, and complete: <br />X Photos X Paperwork X Statement <br />3. [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 possibility of a fine and, <br />imprisonment for known vlolatlons. (HSC25191) Sr. Director West Zone Sales <br />Name: Michael Gray <br />Signatu <br />Title: and Service <br />July 24, 2015 <br />I <br />