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SVV.20.2015 19 :30 209-234-3310 CalSheets LLC #0852 P.002 /027 <br /> • San Joaquin County • EGEIVIZ <br /> Environmental Health Department 1A !1 <br /> 1868 East Hazelton Avenue, Stockton, Califoniia95205-6232 <br /> Telephone;(209)468-3420 Fax., (209)468-3433 Web.www.sioov.om/ehd NOV 2 0 2015 <br /> RETURN TO COMPLIANCE CERTIFICATION ENVIRONMEN7A.i <br /> AnyIfyl NOR 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 Depaifinent(EHD) address <br /> the top of this form within 30 days of receipt of the Inspection Report. HSC 25404A1 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 EHDWlthln 30 days unless otherwise specified in the <br /> Inspection Repoli. HSC 25i65(c)(3) <br /> Note: All END 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 far each violation <br /> Copies of sample resultsrmanifestsrtraining records(other appropriate paperwork, and/or photos verifying correction: <br /> Inspection Date: %r".'r[ ,r s "0 210 l'; Inspected By: <br /> Facility Address ' :'i" 4?OCKTO''N EPA Ia. C11L0003i3�?a7 <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 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 and/ <br /> impriaonmenl for known violeNiom. (H5C 25194) <br /> Name: r. c�+S I_E _clout Title: <br /> Signature; k� Date: i t lea Il 5- <br />