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2016-02-26 14:11 FUEL DELIVERY 12092347295 >> 2094683433 P 2/6 <br /> San Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> relephone:(209)468-3420 Fax:(209)468-3433 Web:www.siaov.org(�hd <br /> FEB 2 6 2016 <br /> RETURN TO COMPLIANCE CERTIFICATION ENWHONMENTAL <br /> AnyIM NOR violations noted in the"Notice to Comply" in the attached Inspection Repoli must be corrected with nl''06f NIT <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 30 days of receipt of the Inspection Report. HSC 25404.1,2(e)(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 witbin 30 dayA unless otherwise specified in the <br /> Inspection Report. HSG 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 records/other appropriate paperwork, and/or photos verifying <br /> corrections <br /> Inspection Date: January 25, 2016 ^ inspected By: STACY RIVERA <br /> Facility Address: 816E FRONTAGE RD, RIPON EPA ID: L <br /> 1 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 authorized to submit this certification on behalf of the Respondent. <br /> 4. I am aware that there are significant penalties for submitting false information, including the possibility of a fine <br /> and/or imprisonment for known violations. (HSC 25191) <br /> Name. C r1 . IQ <br /> Signature:,g(D 0", Date: 2-`2LP 'k(e <br />