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y San Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 �j s <br /> Telephone: (209) 468-3420 Fax: (209)468-3433 Web:www.sigov.or /q ehd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the "Notice to Comply" in the attached Inspection Report must be corrected within 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 HSC 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 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 be taken for each violation <br /> Copies of sample results/manifests/training records/other appropriate paperwork, and/or photos verifying corrections <br /> Inspection Date: August 25, 2016 Inspected By: ELENA MANZO <br /> Facility Address: 1137W LATHROP RD, MANTECA EPA ID: <br /> I certify under penalty of law that: <br /> 1 1 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. 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: [YY�� �Grime� Title:TtCAA -.� ; -- <br /> ` <br /> Signature: IY V/��� A/� ,,_�- � Date: <br /> RETE E.: D <br /> SEP 3 0 2016 <br /> ENVIRONMENTAL HEALTH <br /> DEPARTMENT <br /> PRo:�_310'12 <br />