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San Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue,Stockton,California 952056232 <br /> Telephone:(209)468-3420 Fax:(209)4683433 Web:www sigov ora/ehd <br /> CORRECTIVE ACTIONS(HAZARDOUS WASTE) <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the'Notice to Comply'in the attached Inspection Report must be corrected within 30 days of VIOLATION 103: <br /> receipt of this inspection. This cenification 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(c)(1) Hazardous waste emergency information with all the details including all <br /> All corrections to otherviolations noted in the attached Inspection Report(IR)or Continuation Fonn,or disputes to any equipment information has been posted in sales counter area and at the site <br />_violations-are_to-be-submitted using this certification_and returned to_EHD within 30 do s unless otherwise_specified in the _ IES attached. <br /> Inspection Report. HSC 25185(c)(3) Inforr atio0 ceTtterllrth€backroom:(oop' <br /> Note:All EHD staff time associated with failing to comply by the above noted dates will be VIOLATION 104: <br /> billed at the current hourly rate. <br /> Emergency coordinator information is posted on site.Site is fully prepared for <br /> For this Certification to be complete, theoperatorofthe site must include: emergency response. <br /> A statement documenting what corrective actions were taken or will be taken for each violation <br /> Copies of sample resullis/manifests/baining recordslother appropriate paperwork,and/or photos verifying VIOLATION 117: <br /> corrections <br /> Tnspection Date: November 25,2014 Inspected By: JEFFREY WONG Site will submit all required information including all activities after we receive <br /> from service provider.Please allow us three weeks(by 01-2D-2015)to do this <br /> Facility Address: 4855 S HWY 99 EAST FRONTAGE RD,ST O EPA ID: online with office help. <br /> I certify under penalty of law,that VIOLATION 601: <br /> 1. 1 have connected the violations specified in the Inspection Report from the above-memioned inspection date. <br /> We still working with service provider(safety clean)to dispose the waste.We will <br /> 2. 1 have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION submit a copy of the manifest to the EHD.Please allow us two more weeks. <br /> and I believe the information to be true,accurate,and complete: <br /> _Photos ✓PaperworkStatement VIOLATION 605: <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent. We already In touch with service provider(safety clean)to provide label and new <br /> 4. 1 am aware that there are significant penalties for submitting false information,including the possibility of a fine drum and we will make sure that drum has marked with the required information. <br /> and/or impdsonme I for khown violations. (HSC 25191) <br /> Name: VlE$y1 L( TNe: 'r-V_�Z-1 <br /> Signature: n r Date: /PL—/7—/L <br /> If you have any questions please call meat 209-481-7445 ore-mail me <br /> j2jgill@aol.com <br /> RECEIVE® <br /> JAN ( t 'tA <br /> ENVIROON E TAL HEALTH <br />