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San Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue,Stockton, Califomia95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:yinlim siaov.orglehd <br /> RETURN TO COMPLIANCE CERTIFICATION <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 erections 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 days unless otherwise specified in the <br /> Inspection Report. HSC 25185(c)(3) <br /> Note: All EHD staff time associated with falling 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 resultslmanifestsltraining records/other appropriate paperwork.and/or phots verifying <br /> corrections <br /> Inspection Date: October 17, 2014 Inspected By: GARRETT aACKUS <br /> Facility Address: 4501 N Pershing Ave, Stockton EPA ID <br /> - S_S <br /> 1 certify under penalty of law that <br /> 1. I have corrected the violations specified in the Inspection Report from the above-mentioned irapection date. <br /> 2. 1 have personally examined the fallowing documentation submitted as proof of compliance FOR EACH VIOLATION <br /> and I believe the information to be true, accurate, and completep <br /> Photos V Paperwork Statement <br /> 3. lam authorized to submit this certification on behalf of ft Respondent <br /> 4. 1 am aware that there are significant penalties for submitting false information, including the poasDdity of a l" <br /> and/or imprisonment for known violations. (HSC 25191) <br /> Name: ?.cA e. IIIc, Title: ZeS CNV- Co <br /> �j 'j <br /> Signature: V Q AZ Date: (I 13 i <br />