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San Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www_ . si4ov-or9Lrhd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MI R violations noted in the"Notice to ComplY in the attached Inspection Report must be eotrect� w' 'n 3_0 }L of <br /> receipt of this inspection. This certification form must be submitted to the Environmental Health Department(EHD) 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 cQ rections to q r vio at his noted in the attached inspection Report(1R}or Continuation Form, <br /> erwise spec fedor disputes to nn the <br /> violations, are to be submitted usingthis certification and returned to EHD within 3Q, <br /> Inspection Report. HSG 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 o will be taken <br /> nfach violation verifying <br /> Gopies of sample results/manifests/training recordslother appropriate <br /> corrections <br /> Inspection Date: October 13, 2014 - Inspected By: ELENA MANZO <br /> Facility Address: 1399N MAIN ST, Manteca EPA ID: <br /> I certify under penatty 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�liowina documentation submitted as proof of compliance FOR EACH VlOtATION <br /> and I believe the information <br /> d complete: <br /> Photos_____Paperwork X 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 possibility of a fine <br /> and/or imprisonment for known violations. (HSC 25191) <br /> Name: <br /> Stephen Boyd Title; Rg. Gasoline Env. ConjjD . Mqr. <br /> Signature: rek, A Date: 11/5/2014 <br />