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05/09/2016 11:08 2099293919 KIM POTTS PAGE 01101 <br /> San Joaquin County `mss <br /> Environmental Health Department <br /> 1888 East Hazelton Avenue, Stockton, California 95205-6232 MAY 09 2016 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:y,&_w.siGov.ora/ehd <br /> RETURN TO COMPLIANCE CERTIFICATIOW t <br /> Any MIN QR violations noted In the"Notice to Comply" in the attached Inspection Report must be 2gggcted within 30,days 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 omeLi tions_to_other_vi.olatiotls 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 1 Hp within 30 da_v_s.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: April27, 2016 Inspected Ey: STACY RIVERA <br /> Facility Address: 3239 S EL DORADO ST, STOCKTON EPA, ID:. ( C1190 QYJ_ (f <br /> I certify under penalty of law that: <br /> I. 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 <br /> I believe the information to be true, accurate, and complete: <br /> „Photos PaperworkStatement <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 possibility of a fine and/ <br /> imprisonment for known violations. (HSC 25191) <br /> Name: v i' Title: Pil145 It <br /> Signature: Date: <br /> #VLj;;11601 <br /> -144 A1 <br /> C" ,r 7X <br />