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01/27/2015 8:30 AN FAX 2093695529 Tractor Supply Co 1857 Z0006/0011 <br /> San Joaquin County <br /> Environmental Health Department RECEIVED 1868 East Hazelton Avenue, Stockton, California 952D5-6232 G <br /> Telephone: (209)468-3420 Fax: (209)468.3433 Web: A y g dbv o a g <br /> RETURN TO COMPLIANCE CERTIFICATION JAN 2 7 2015 <br /> Any MINOR violations noted in the"Notice to Comply" in the attached Inspection Report must be c NVIRONMENTA-o�' <br /> receipt of this inspection. This certification form must be submitted to the Environmental Health Department(EHp) address <br /> at the top of this form within 30 days of receipt of the Inspection Report. HSC 25404.1.2(c)(1) <br /> All i n 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 /> 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 betaken for each violation <br /> Copies of sample results/manifestsRraining records/other appropriate paperwork, and/or photos verifying <br /> corrections <br /> Inspection Date: December 29. 2014 Inspected By: MICHELLE HENRY <br /> Facility Address: 360 S Cherokee Ln, Lodi EPA Ip <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 /> and 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 <br /> and/or imprisonment for known violations. (HSC 25191) <br /> Name: Title: <br /> Signature: Date: <br />