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06/03/2015 10: 15 8387674 EMILS PAGE 06 <br /> San Joaquin County <br /> Environmental Health Department RPCC( IVEL) <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 V <br /> Telephone:(209)406-3420 Kix:(209)468-3433 Web:www.giaov.orglehd <br /> RETURN TO COMPLIANCE CERTIFICATION AN 0 3 2015 <br /> EAVIROP '1=IVTAI, <br /> Any MINOR violations noted in the"Notice to Comply" in the attached Inspection Report must be ctlftktdd Wjtbin9adevs of <br /> receipt of this inspection. This certification form must be submitted to the Environmental Health Department(EHD) address <br /> the top of this form within 30 days of receipt of the Inspection Report. HSC 25404.1.2(c)(1) <br /> All corrections to othy f 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 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 for each violation <br /> Copies of sample results/manifeststtraining records/other appropriate paperwork, and/or photos verifying corrections <br /> Inspection Date: May 06, 2015 Inspected By: ELENA MANZO <br /> Facility Address: 1405 CALIFORNIA ST, ESCALON EPA 117. <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. t have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION <br /> believe the information to be true, accurate, and <br /> complete: <br /> Photos V Paperwork_VStatement <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 /> imprisonment for known violations. (HSC 25191) n� <br /> Name: �ame �cl ,e� c el' Title-O&.0 (ho inUS_._y <br /> Signatur : rr� c�G� ��� Date: ��� IS J <br />