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AASRA PETRO 1%.�IM, INC 209F496100 p.1 " <br /> 4-r 7,0: t E NA Yr"z-tn <br /> k 1 San Joaquin County AUG 0 4 2016 <br /> Environmental Health De artment <br /> 1868 East Hazelton Avenue, Stockton, alifomia 95205-6232 �+�► A <br /> Telephone:(209)468-3420 Fax:(209)468-34 33 web:vmtnu.slgov oro/ehd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the'Notice to Comply"in the attached In ion Report must be torr ted within 30 da s of <br /> receipt o this inspection. This certification form must be submitted to the nvironmental Health Department(EHD)address at <br /> the top of this form within 30 days of receipt of the Inspection Report. HS 25404.1.2(c)(1) <br /> All Corrections to other violations noted in the attached Inspection Report (I:?)or Continuation Form, or disputes to any violations, <br /> are to 51 su <br /> HSC 2518bmitted using t is certification and retumed to EHD within 30 d <br /> 5(c)(3) s unless <br /> ess otherwise specified in the Inspection Report. <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 he site must include: <br /> A statement documenting what corrective actions were taken or will be tak n for each violation <br /> Copies of sample results/manifests/training records/other appropriate papa work, and/or photos verifying corrections <br /> Operator's certification - - <br /> I ne T= S a`Le do..E ,. `� ll'WI Wou� ON 0v1 lr1 `J-l. <br /> Inspection Date: October 28,2013 nspected By: Elena Manzo <br /> Facility Address: 1340 W Colony Rd EPA ID: <br /> order penalty of law that: <br /> have corrected the violations specified in the Inspection Report from the at ove-mentioned inspection date. <br /> I have personally examined the following documentation submitted as proof Df 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 informatio , including the possibility of a fine and/or <br /> imprisonment for known violations. (HSC 25191) <br /> Name: kIln15CE T Q,r 4 H Title: C4-0 <br />