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-64/15/2615 21:49 51079E347G SH`RNt` <br /> San Joaquin County <br /> Environmental Health Department APR 16 2015 <br /> 1868 East Hazelton Avenue, Stockton, California 05205-6232 <br /> Teiephone:(209)468-3420 Fax: (209) 468-3433 Web:www,s' 1DV Oqleta ,VIRON ENTA!_. <br /> R!TU <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINQR violations noted in the"Notice to Comply' in the attached Inspection Report must be corrected within 3o daysof <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 o er 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 EHQwithin 3Q days unless otherwise specified in the <br /> inspection Report. HSG 25185(c)(3) <br /> Note: All EHD staff fine 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/manifestsltraining records/other appropriate paperwork, and/or photos verifying correction, <br /> Inspection Date- {liar-ch 17, 2,0=5 Inspected By: F[ e=NA Wi/\ ZC) <br /> Facility Address: 0ti , 9�1� 6N � IL�AN""`l CA EPA ID:_�-i't-• , 0U b S S5"L <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 VIOtATIO <br /> I believe the information to be true, accurate,and complete: <br /> Photos/_Paperwork X. Statement <br /> 3. lam 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: U1..D - Title: <br /> Signature: �-� _Dates U5 <br />