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05/09/2016 11:03 2099293919 KIM POTTS PAGE 01/06 <br /> San Joaquin County <br /> Environmental Heatth Department <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 MAY 09 <br /> Telephone:(209)4683420 Fax:(209)468-3433 Web:www.sigoq v_ora/ehd <br /> ` U <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the"Notice to Comply" in the attached Inspection Report must be corrected withi.a.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. MSC 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 EHl7 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: April 27, 2016 Inspected By: STACY RIVERA <br /> Facility Address: 3239 S EL DORADO ST, STOCKTON EPA ID: <br /> I certify under penalty of law that: <br /> 1. 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_Paperwork Statement <br /> 3, I 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: i Title: --__. 5 cSt �c <br /> Signature: Date: 16 <br /> 2 6t-,e, ci & �l <br /> L L.. .� <br /> MAY 092Wa <br />