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San Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue,Stockton,California 95205-6232 <br /> Telephone:(208)468-3420 Fax:(209)468-3433 Webr www,gkov.om/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 3D days of <br /> receipt of this inspection. This certification form must be submitted to the Environmental Health Department(EHO)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 <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 abovs 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 papenaork,and/or photos verifying corrections <br /> Inspection Date: February 18, 2016 Inspected By: CINDY VO <br /> Facility Address: 1700 N BROADWAY AVE, STOCKTON EPA 10: g5s-2— <br /> P <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 and <br /> 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. 1 am aware that there are significant penalties for submtring false information,including the possibility of a fine and/or <br /> imprisonment for known violations, (HSC 15191) <br /> Name g � Title:- :5WF7Z <br /> Signature. Date: <br />