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San Joaquin County <br /> EnvironMental Health Department <br /> �12,D 1, 868 East Hazelton <br /> ' AvenueStockton, Californiafi2 <br /> 32 <br /> relephone.(209)468-3420 Fax:(2 ) 3yww svor 1 hd <br /> RETURN TO COMPLIANCE CERTIFICATION NOV 12 2014 <br /> Any MINOR violations noted in the"Notice to Comply" in the attached Inspection Report must be Lorre <br /> wit in 30 d of <br /> receipt of this inspection. This certification farm must rbise submitted to the ec on Report NSC 54Q4.121( c)(1)th Department(EFiD)address <br /> at the top of this form within 30 days of receipt of the p <br /> All co recti s to her 1 do noted in the attached Inspection Report(IR)ar Continuation Form,or disputes to any <br /> ing this certification and returned to EMD withit�30 data unless otherwise specified in the <br /> violations, are to be submitted us <br /> Inspection Report. NSC 25185(c)(3) <br /> Not*, All EHp 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, <br /> the operator of the site must include:. <br /> lation <br /> A statement documenting what tswain ng rrrective tecords/other appropriate paperwork, and/oions were taken or will be taken for each r verifying <br /> Copies of sample results/man <br /> corrections <br /> Inspected By: STACY RIVERA <br /> Inspection Date: October 15, 20'14 <br /> Facility Address. <br /> $2$8 S EL DORADO ST FRENCH CAMP 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 /> l have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION <br /> 2. <br /> and i believe the information to be true,accurate,and co p <br /> PhotosPaperworkStatement <br /> 3. I am authorized to submit this certification on behalf of the Respondent. <br /> 4. 1 am aware that there are significant penaltiessubmitting false information,including the possibility of a fine <br /> and/or imprisonment for known violations. (HSC 251 9 ) <br /> Title: <br /> Name: o �' / <br /> Date: t � l I l _ L4 - <br /> Signature: <br />