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San Joaquin County <br /> EIVE <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 MAR U 3 2016 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web: /ehd <br /> ENVIRONMENTAL <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations rioted in the "Notice to Comply'in the attached Inspection Report must be corrected within 30 days of 7 <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 /> Nate: 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: 1=ebruary 02, 21016 Inspected By: STACK+` RI1/ERA <br /> Facility Address; 3730E MUNFORD AVE, STOCKTON EPA ID: <br /> I ceft;fy under penalty of law that <br /> 1. 1 have corrected the violations specified in the Inspection Report from the above-mentioned inspection date, <br /> 2. 1 have personally examined the following documentatlon submitted as proof of compliance FOR EACH VIOLATION <br /> I belleve the information to be true, accurate,and complete, <br /> Photos _ paperwork Statement <br /> 3- tam authorized to submit this certification on behalf of the Respondent. <br /> 4. lam aware that there are significant penalties for submitting false information,including the possibility of a fine and/ <br /> imprisonment for known violations. (HSC 25191) <br /> Name: �l 115 12 Title: OW r.,R <br /> Signature: Date: _ � ) }41 b <br /> �3c>3 CCt� bb,2b2 , 3q <br />