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San Joaquin County APR 2 5 2011 <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Telephone:(209)468-3420 pax:(209)468-3433 Web:www.sIgov.orglilld 'IRONMEI TAL HEALTH <br /> DEPAR +~TIENT <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any I OR violations noted in the"Notice to Comply"in the attached Inspection Report must be cQrCQgWd within 0 days of <br /> receipt of this inspection. This certification form must be submitted to the Environmental Health Department(EH )address <br /> at the top of this form within 30 days of receipt of the inspection Report HSG 25404.12(c)(1) <br /> All ccrrections to othetiyjolatons noted in the attached Inspection Report(IR)or Continuation Form, or disputes tc any <br /> violat uns, are to be submitted using this certification and returned to EHD within 30 days unless otherwise speci%i d in the <br /> Insp tion Report. HSC 25185(c)(3) <br /> Not,.,, 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 <br /> corrections <br /> Inspection Date: April 10, 2017 Inspected By: VICKI MCCARTN EY <br /> Facility Address: 4315 E WATERLOO RD, STOCKTON CERS ID: 10181465 <br /> 11 cert under penalty of law that.- <br /> 1. I <br /> hat: <br /> 1. I have corrected the violations specified in the Inspection Report from the above-mentioned inspection d e. <br /> I have personally examined the following documentation subm=Statement <br /> mpliance FOR EACH VIOLATION <br /> and l believe the information to be true, accurate, and complete <br /> Photos Paperwork <br /> i am authorized to submit this certification on behalf of the Respondent <br /> I am aware that there are significant penalties for submitting false information, including the possibility of a fine <br /> and/or imprisonment for known violations. (NSC 25191) <br /> Title: <br /> ignature: bate: <br /> Z00/ Zo0'd SZ60# te964££60Z 9Z:31 LTOZ/SZ1t0 <br />