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EHD Page 2 of 4 2014.11-14 00:52:43(GMT) 12097626954 From:RAVINDER SINGH <br /> jM 4 � ' ' t ��(C� San Joaquin County E C t i v D <br /> I Environmental Health Department <br /> 1868 East Hazelton Avenue,Stockton, California 95205-6232 NOV 13 2014 <br /> Telephone:(209)468-3420 Far:(209)468-3433 Web:www.slgov.org(ehd <br /> RETURN TO COMPLIANCE CERTIFICATION ENVIRONMENTAL HEALTF <br /> DEPAF HENT <br /> Any MINOR violations noted in the"Notice to Comply'in the attached Inspection Report must be corrected within�O 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 3D 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/manffests/training records/other appropriate paperwork;andlor photos verifying. <br /> corrections <br /> Inspection Date: October 14, 2014 Inspected By: STACY RIVERA <br /> Facility Address: 508 W Charter Way, Stockton EPA ID: r2G, y <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. 1 have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION <br /> and I believe the information to be true,accurate, and complete: <br /> Photos Paperwork_Statement <br /> 3. 1 am authorizedto.submit this certification on behalf of the Respondent. <br /> 4. 1 am aware that there aresignificant penalties forsubmitting false information, including the possibility of a fine <br /> and/or <br /> ri�imprisonment for known(v`iiolatiobs. (HSC25191) <br /> Name:_Ona I I i�aA-, ��t� Title:V- 9 <br /> Signature: _,t` : Date: <br />