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<� • San Joaquin County • <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, California 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.org/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 30 das 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 records/other appropriate paperwork, and/or photos verifying corrections <br />Inspection Date: July 12, 2016 Inspected By: STACY RIVERA <br />Facility Address: 18754 E HWY 26 LINDEN EPA ID. <br />I certify under penalty of law that: <br />1. 1 have corrected the violations specified in the Inspection Report from the <br />2. ]have personally examined the following documentation submitted as proof of compliance F(3~(MCr)t <br />and I believe the information to be true, accurate,/and complete: J <br />Photos VPaperwork Statement �( 192016 <br />3. 1 am authorized to submit this certification on behalf of the Respondent. �NV'R�Nti1F/VlAC <br />D <br />FPa H; <br />4. 1 am aware that there are significant penalties for submitting false information, including the <br />and/or imprisonment for known violations. (HSC 25191) <br />Arte,g,7 /;'�' <br />rtuW 11xti�', Iii lN1N(7 : Ar -ha L 'lraintKj Ee6Dc}c6wncviT) fe[er2t) <br />D15pr�tsc2 <br />_71f — l.t� hYeek -- SLS clvarr- cv2-BP4- <br />a1k64(l �o 61� `Celre4 <br />