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0 San Joaquin County • RECILIED <br /> Environmental Health Department �/ <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 MAR 14 2016 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.orn/ehd <br /> EN IIEONM SER L H <br /> RETURN TO COMPLIANCE CERTIFICATION WCEALT" <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 /> 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 <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/manifests/training recordslother appropriate paperwork, and/or photos verifying corrections <br /> Inspection Date: February 22, 2016 Inspected By: STACY RIVERA <br /> Facility Address: 4800 S AIRPORT WAY STOCKTON EPA ID: <br /> I certify under penalty of law that: <br /> 1. 1 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 /> 1 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 /> imprisonment for known violations. (HSC 25191) /] <br /> Name:<117 m / Tiitle: l�JSli��c Sc�An; SH�v ✓,sa( <br /> Signature: - Date: 31b 4.2v!(� <br /> o26y �! 'n tecX [7a � /1ek> Mon, or .ate P <to, � <br /> N.�4 -Fv <br /> DQera1'e ct have 6>, s14e, Also <br />