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San Joaquin County <br /> FILE COPY <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjaov.oro/ehd <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 ddaus of <br /> receipt of this inspection. This certification form must be submitted to the Environmental Health Department (EHD) address at <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 other violations noted in the attached Inspection Report(IR)or Continuation Form, or disputes to any violations, <br /> are to be submitted using this certification and returned to EHD within 30 days unless otherwise specified in the Inspection Report. <br /> HSC 25185(c)(3) <br /> All EHD staff time associated with failing to comply by the above noted dates will be billed at the <br /> 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/manifests/training records/other appropriate paperwork, and/or photos verifying corrections <br /> Operator's certification <br /> Inspection Date: October 28, 2013 Inspected By: Elena Manzo <br /> Facility Address: 1340 w Colony Rd EPA ID: <br /> ender penalty of law that: <br /> I have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. <br /> I have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION and I believe <br /> the information to be true, accurate, and complete: <br /> Photos Paperwork Statement <br /> I am authorized to submit this certification on behalf of the Respondent. <br /> I am aware that there are significant penalties for submitting false information, including the possibility of a fine and/or <br /> imprisonment for known violations. (HSC 25191) <br /> Name: Title: <br />