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R. Phillips Trucking.11c 2011-948-0840 p.2 <br /> SAN JOAQUIN COUNTY RECEIVE[ <br /> ENVIRONMENTAL HEALTH DEPARTMENT FEB 13 2014 <br /> 868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Telephone: (205)468-3420 Fax: (209)458-3433 Web:www.sigoy.orq/ehd <br /> ENVIRONMENTAL HEALTH <br /> UEPARTMENT <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the "Notice to Comply' in the attached Inspection Report must be <br /> corrected within 30 days of receipt of this inspection. This certification form must be submitted to the <br /> Environmental Health Department (EHD) address at the top of this form within 30 days of receipt of the <br /> 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 <br /> disputes to any violations, are to be submitted using this certification and returned to EHD within 30 days <br /> unless otherwise specified in the 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 t0 be compete 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 resultsi'manifests/training recordslother appropriate paperwork, and/or photos <br /> verifying corrections <br /> • Operator's certification <br /> Inspection Dat" Inspected By:Jeffrey Wong <br /> Facility Address: EPA ID#:eAZ- >�2 Al,� 7-2 <br /> 1 certify under penalty of law that: <br /> 1. 1 have corrected the violations specified in the Inspection Report from the above-mentioned <br /> inspection date. <br /> 2. 1 have personally examined the following documentation submitted as proof of compliance FOR <br /> EACH VIOLATION and I believe the information to be true, accurate, and complete: <br /> I <br /> Photos 1� 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 submitting false information, including the <br /> possibility of a fine and/or impriscnmeent for known violations. (HSC 25191) <br /> Name: // Title: 1,2y1e c <br /> Signa e. D <br /> Edi D 22-C 2-DOS Rev 041'9/12 <br />