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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 sigov org/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: July 14 2016 Inspected By: -LENA 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: �.�„ .'F�� Title: _ c, ;ar>� ��,e�a1►cnr� <br /> Signature: . Date: <br /> AUG.9 }� <br />