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RECEIVED <br /> MAY 0 7 2014 <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH <br /> ENVIRONMENTAL FiEAI:rH DEPARTMENT DEPARTMENT <br /> 1803 East Hazehor Avenue, Stockton.California 952105-6232 <br /> Telephone:(2091 466-3420 Fax:(239)465-3433 Web:wNwr.s1gov.oralehd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any IV INOR violations noted in the 'Notice to CompY in the atiachad Inspection Repor{ must be <br /> corrected wi!hin 30 days of recei.t of this inspection This certification form must oe submitteo to the <br /> EnvircrimeRtal Health Department�EHG j address at the top of this form within 30 days of reGPipt of the <br /> Inspection Report. HSC 254Q4 1.2!c)kl) <br /> Al! corrections to other violations noted in the attacher! tnspectaon Report(IR) or Continuation Form,or <br /> disputes to any vicfafions, are to be submitted ising this certification and returned to EHD within 30(jays <br /> unless otherwise specr5ed in the Inspection Report. HSC 25'&5-'cj(3) <br /> Note. All EHD staff time associated with failing Eo comply by the above noted dates will be <br /> Wiled at the current hourly rate. <br /> For this certification to be complete the operator of the site must include <br /> • A s!atement documenting what corrective actions were taken cr will be!aken for each violaticp. <br /> • Copies of sample re5utts.1manifests/trair.ing records/other appropriate paperwork, andlor photcs <br /> veriNing corrections <br /> • Operator's certification <br /> lnspec.tion Date:—JL ` Inspected By:Elena Manzo <br /> - - -- <br /> �4 ° EPA ID#: <br /> Facility Address: <br /> I certt/ under penalty of law That: <br /> 4 1 I have corrected the violations specified in th.e Inspection Report from the above-mentioned <br /> ` inspection date I <br /> 2. f have personany examined the following documentation submitted as proof of compliance FOR <br /> EACH VtOLATIQN and I believe the information to be true, accurate, and complete <br /> I <br /> Photos _Paperwork <br /> , Statement <br /> I <br /> 3 i am authorized to su:,,init thus certification or, baha'f of the Respondew. j <br /> a i am ativare that there are significant penalties for subm. Ing fa.'se information,including the <br /> posit fiy of a fine andlor imprisonment for kn,.mn v10lationS rHSC 25191► <br /> I <br /> Name.__ � -?o Tit?e:_ l <br /> �/ to l <br /> Signature: — Dale: <br /> d Z l,K9E8809 �c�aJeun <br />